Healthcare Provider Details

I. General information

NPI: 1073280434
Provider Name (Legal Business Name): SIDRAH M KHAN FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/24/2021
Last Update Date: 08/12/2024
Certification Date: 08/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1920 L ST NW STE 350
WASHINGTON DC
20036-5072
US

IV. Provider business mailing address

1920 L ST NW STE 350
WASHINGTON DC
20036-5072
US

V. Phone/Fax

Practice location:
  • Phone: 916-267-7947
  • Fax: 240-403-7893
Mailing address:
  • Phone: 202-296-4002
  • Fax: 240-403-7893

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF09210533
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF09210533
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: