Provider Demographics
NPI:1811740442
Name:KHAN, AYESHA DEEN (MD)
Entity type:Individual
Prefix:DR
First Name:AYESHA
Middle Name:DEEN
Last Name:KHAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:FNU
Other - Middle Name:
Other - Last Name:AYESHA KHAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:300 EAST WASHINGTON ST.
Mailing Address - Street 2:UNIT 404
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13202-1584
Mailing Address - Country:US
Mailing Address - Phone:416-906-8945
Mailing Address - Fax:
Practice Address - Street 1:550 EAST GENESEE STREET
Practice Address - Street 2:EN-STAT
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13202
Practice Address - Country:US
Practice Address - Phone:315-464-4851
Practice Address - Fax:315-464-4854
Is Sole Proprietor?:No
Enumeration Date:2024-04-11
Last Update Date:2025-02-04
Deactivation Date:2024-11-22
Deactivation Code:
Reactivation Date:2025-02-04
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program