MEDICARE: SARAH KHAN MS, CGC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	170300000X	Genetic Counselor (M.S.)

General Provider Information

NPI Number	:	1558857821
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SARAH KHAN MS, CGC

Provider Business Mailing Address
First Line	:	15255 MAX LEGGETT PKWY STE 6000
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32218-7278
Country	:	US
Telephone Number	:	904-427-8603
Fax Number	:

Provider Business Practice Location Address
First Line	:	15255 MAX LEGGETT PKWY STE 6000
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32218-7278
Country	:	US
Telephone Number	:	904-427-8603
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/10/2018
Last Update Date	:	12/23/2019

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