Healthcare Provider Details

I. General information

NPI: 1295316891
Provider Name (Legal Business Name): NIKHAT NAFEEZA KHAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: NIKHAT NAFEEZA AZAM

II. Dates (important events)

Enumeration Date: 04/16/2021
Last Update Date: 09/22/2026
Certification Date: 09/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

506 CROMWELL AVE STE 201
ROCKY HILL CT
06067-1852
US

IV. Provider business mailing address

506 CROMWELL AVE STE 201
ROCKY HILL CT
06067-1852
US

V. Phone/Fax

Practice location:
  • Phone: 860-529-1287
  • Fax: 860-721-6311
Mailing address:
  • Phone: 860-529-1287
  • Fax: 860-721-6311

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number79254
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: