Healthcare Provider Details

I. General information

NPI: 1184268401
Provider Name (Legal Business Name): STEPHANIE KHAN RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/30/2019
Last Update Date: 10/30/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25 MARGETTS RD
MONSEY NY
10952-5023
US

IV. Provider business mailing address

9 RAKE ST APT 1
HARRIMAN NY
10926-3247
US

V. Phone/Fax

Practice location:
  • Phone: 845-577-6190
  • Fax:
Mailing address:
  • Phone: 914-258-4362
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0200X
TaxonomyPediatric Registered Nurse
License Number775387
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: