Healthcare Provider Details

I. General information

NPI: 1538079215
Provider Name (Legal Business Name): SUMAYYA KHAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/08/2026
Last Update Date: 09/08/2026
Certification Date: 09/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 E MAIN ST
MILFORD MA
01757-2806
US

IV. Provider business mailing address

23 TANGLEWOOD DR
NORTH EASTON MA
02356-2734
US

V. Phone/Fax

Practice location:
  • Phone: 508-634-3882
  • Fax: --
Mailing address:
  • Phone: 617-816-2684
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: