Provider Demographics
NPI:1013237247
Name:KHAIRA, SIMREET
Entity Type:Individual
Prefix:
First Name:SIMREET
Middle Name:
Last Name:KHAIRA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:205 E ST # TH-1
Mailing Address - Street 2:
Mailing Address - City:SOUTH BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02127-2874
Mailing Address - Country:US
Mailing Address - Phone:559-708-9104
Mailing Address - Fax:
Practice Address - Street 1:205 E ST # TH-1
Practice Address - Street 2:
Practice Address - City:SOUTH BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02127-2874
Practice Address - Country:US
Practice Address - Phone:617-209-9146
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-10
Last Update Date:2022-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2451502084P0800X
MA2618042084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry