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General NPI Number Information
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NPI Number | 1689669509
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Entity Type | Individual
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Provider Name | SOOFIA KHAN MD
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Gender | Female
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Dates
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Enumeration Date | 09/16/2005
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Last Update Date | 08/10/2023
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Provider Practice Location Address
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Address Line | 240 BLUESTONE PL
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City | CASSELBERRY
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State | FL
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Zip | 32707-4147
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Country | US
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Telephone | 305-731-4618
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Fax | 321-972-3809
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Provider Business Mailing Address
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Address Line | 240 BLUESTONE PL UNIT 5
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City | CASSELBERRY
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State | FL
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Zip | 32707-4147
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Country | US
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Telephone | 305-731-4618
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Fax | 321-972-3809
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number | ME94533
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License Number State | FL
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