Provider Demographics
NPI:1689669509
Name:KHAN, SOOFIA (MD)
Entity Type:Individual
Prefix:DR
First Name:SOOFIA
Middle Name:
Last Name:KHAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:240 BLUESTONE PL UNIT 5
Mailing Address - Street 2:
Mailing Address - City:CASSELBERRY
Mailing Address - State:FL
Mailing Address - Zip Code:32707-4147
Mailing Address - Country:US
Mailing Address - Phone:305-731-4618
Mailing Address - Fax:321-972-3809
Practice Address - Street 1:240 BLUESTONE PL
Practice Address - Street 2:
Practice Address - City:CASSELBERRY
Practice Address - State:FL
Practice Address - Zip Code:32707-4147
Practice Address - Country:US
Practice Address - Phone:305-731-4618
Practice Address - Fax:321-972-3809
Is Sole Proprietor?:No
Enumeration Date:2005-09-16
Last Update Date:2023-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME94533208100000X
TN43370208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation