Provider Demographics
NPI:1356924583
Name:KHANNA, SHEFALI (MD)
Entity type:Individual
Prefix:
First Name:SHEFALI
Middle Name:
Last Name:KHANNA
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 1:701 GROVE ROAD
Mailing Address - Street 2:4TH FLOOR SUPPORT TOWER (ATTN: CASSANDRA KELLY)
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29605
Mailing Address - Country:US
Mailing Address - Phone:864-455-5198
Mailing Address - Fax:304-388-8238
Practice Address - Street 1:701 GROVE ROAD
Practice Address - Street 2:4TH FLOOR SUPPORT TOWER
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29605
Practice Address - Country:US
Practice Address - Phone:864-455-5198
Practice Address - Fax:304-388-8238
Is Sole Proprietor?:No
Enumeration Date:2021-05-05
Last Update Date:2024-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program