Healthcare Provider Details

I. General information

NPI: 1144642406
Provider Name (Legal Business Name): SHANA VALLIANI KHAN C.R.N.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/06/2014
Last Update Date: 12/09/2020
Certification Date: 12/08/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

651 E 25TH ST
HIALEAH FL
33013-3814
US

IV. Provider business mailing address

6250 NW 114TH ST
HIALEAH FL
33012-2333
US

V. Phone/Fax

Practice location:
  • Phone: 305-693-6100
  • Fax:
Mailing address:
  • Phone: 305-725-1792
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberRN 9279629
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: