Provider Demographics
NPI:1851628135
Name:KHAN, SHAHNAWAZ B (MD)
Entity Type:Individual
Prefix:DR
First Name:SHAHNAWAZ
Middle Name:B
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 1:2 PEBBLE BEACH CT
Mailing Address - Street 2:
Mailing Address - City:MONROE TOWNSHIP
Mailing Address - State:NJ
Mailing Address - Zip Code:08831-5130
Mailing Address - Country:US
Mailing Address - Phone:732-656-3175
Mailing Address - Fax:
Practice Address - Street 1:2 PEBBLE BEACH CT
Practice Address - Street 2:
Practice Address - City:MONROE TOWNSHIP
Practice Address - State:NJ
Practice Address - Zip Code:08831-5130
Practice Address - Country:US
Practice Address - Phone:732-656-3175
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-08
Last Update Date:2009-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY160992208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice