Healthcare Provider Details

I. General information

NPI: 1548932205
Provider Name (Legal Business Name): SARWAT KHAN MPH, PMHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/01/2021
Last Update Date: 07/05/2022
Certification Date: 07/05/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18 E 48TH ST RM 1202
NEW YORK NY
10017-1038
US

IV. Provider business mailing address

1962 HORATIO AVE
MERRICK NY
11566-2604
US

V. Phone/Fax

Practice location:
  • Phone: 212-980-5600
  • Fax:
Mailing address:
  • Phone: 516-528-6000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number403779
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: