Healthcare Provider Details

I. General information

NPI: 1912810227
Provider Name (Legal Business Name): NOOR KHAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/26/2026
Last Update Date: 09/26/2026
Certification Date: 09/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1580 NW 128TH DR APT 110
SUNRISE FL
33323-5216
US

IV. Provider business mailing address

1580 NW 128TH DR APT 110
SUNRISE FL
33323-5216
US

V. Phone/Fax

Practice location:
  • Phone: 954-803-2438
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: