Provider Demographics
NPI:1710694245
Name:KHAN, MUHAMMAD SHOAIB (RN)
Entity Type:Individual
Prefix:
First Name:MUHAMMAD
Middle Name:SHOAIB
Last Name:KHAN
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33 WILSTAN AVE
Mailing Address - Street 2:
Mailing Address - City:PATCHOGUE
Mailing Address - State:NY
Mailing Address - Zip Code:11772-2253
Mailing Address - Country:US
Mailing Address - Phone:917-702-4823
Mailing Address - Fax:
Practice Address - Street 1:33 WILSTAN AVE
Practice Address - Street 2:
Practice Address - City:PATCHOGUE
Practice Address - State:NY
Practice Address - Zip Code:11772-2253
Practice Address - Country:US
Practice Address - Phone:917-702-4823
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-03
Last Update Date:2022-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY824656163WP0808X, 163WG0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice
No163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health