Healthcare Provider Details

I. General information

NPI: 1285089672
Provider Name (Legal Business Name): MOHAMMAD KHAN D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: MOHAMMAD SHEHRYAR KHAN D.O.

II. Dates (important events)

Enumeration Date: 05/04/2016
Last Update Date: 08/24/2025
Certification Date: 08/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1131 S ORANGE AVE
ORLANDO FL
32806-1226
US

IV. Provider business mailing address

ONSPOT DERMATOLOGY 1131 SOUTH ORANGE AVENUE, ORLANDO FL 33806
KISSIMMEE FL
34741-4709
US

V. Phone/Fax

Practice location:
  • Phone: 941-444-0011
  • Fax:
Mailing address:
  • Phone: 480-659-8226
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number009736
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code207ND0900X
TaxonomyDermatopathology Physician
License NumberOS21641
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateCA
# 4
Primary TaxonomyY
Taxonomy Code207ZD0900X
TaxonomyDermatopathology (Pathology) Physician
License NumberOS21641
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: