Healthcare Provider Details

I. General information

NPI: 1093897761
Provider Name (Legal Business Name): SHEHARYAR S KHOKHAR MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/20/2006
Last Update Date: 02/13/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1561 LONG POND RD SUITE 302
ROCHESTER NY
14626-4117
US

IV. Provider business mailing address

100 KINGS HWY S
ROCHESTER NY
14617-5504
US

V. Phone/Fax

Practice location:
  • Phone: 585-723-1120
  • Fax: 585-723-1776
Mailing address:
  • Phone: 585-922-0553
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number225993
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: