Provider Demographics
NPI:1457554529
Name:KHAN, SYEDA SUMERA (MD)
Entity Type:Individual
Prefix:
First Name:SYEDA
Middle Name:SUMERA
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 1:7981 GLADIOLUS DR
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33908-5123
Mailing Address - Country:US
Mailing Address - Phone:239-939-0999
Mailing Address - Fax:239-939-1070
Practice Address - Street 1:7981 GLADIOLUS DR
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33908-5123
Practice Address - Country:US
Practice Address - Phone:239-939-0999
Practice Address - Fax:239-939-1070
Is Sole Proprietor?:No
Enumeration Date:2007-06-07
Last Update Date:2022-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME98271174400000X, 207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL2787172 00Medicaid