Healthcare Provider Details

I. General information

NPI: 1548597180
Provider Name (Legal Business Name): MAHPARA SHERJIL KHAN M.D
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/03/2009
Last Update Date: 01/29/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2094 ALBANY POST RD
MONTROSE NY
10548-1454
US

IV. Provider business mailing address

2094 ALBANY POST RD
MONTROSE NY
10548-1454
US

V. Phone/Fax

Practice location:
  • Phone: 914-737-4400
  • Fax:
Mailing address:
  • Phone: 914-737-4400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number249417
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number249417
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: