Healthcare Provider Details

I. General information

NPI: 1154319929
Provider Name (Legal Business Name): FARIDA KHAN-SEWANI MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/06/2005
Last Update Date: 12/15/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2600 S RAINBOW BLVD #108
LAS VEGAS NV
89146-4006
US

IV. Provider business mailing address

2809 CRYSTAL BEACH DR
LAS VEGAS NV
89128-6908
US

V. Phone/Fax

Practice location:
  • Phone: 702-655-1400
  • Fax: 702-685-0612
Mailing address:
  • Phone: 702-858-7376
  • Fax: 702-685-0612

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number9753
License Number StateNV
# 2
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number9753
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: