Healthcare Provider Details

I. General information

NPI: 1922425420
Provider Name (Legal Business Name): SAIRA KHAN PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/21/2014
Last Update Date: 02/20/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8645 W BOYNTON BEACH BLVD
BOYNTON BEACH FL
33472-4415
US

IV. Provider business mailing address

2475 NW 41ST ST
BOCA RATON FL
33431-8420
US

V. Phone/Fax

Practice location:
  • Phone: 561-737-6336
  • Fax:
Mailing address:
  • Phone: 561-212-6842
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License NumberPA9107793
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: