Provider Demographics
NPI:1124812243
Name:KHAN, AYESHA ALI
Entity type:Individual
Prefix:
First Name:AYESHA ALI
Middle Name:
Last Name:KHAN
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7201 PRINCETON AVE APT 6
Mailing Address - Street 2:
Mailing Address - City:COLLEGE PARK
Mailing Address - State:MD
Mailing Address - Zip Code:20740-3328
Mailing Address - Country:US
Mailing Address - Phone:240-886-7101
Mailing Address - Fax:
Practice Address - Street 1:4000 GARDEN CITY DR STE 810
Practice Address - Street 2:
Practice Address - City:HYATTSVILLE
Practice Address - State:MD
Practice Address - Zip Code:20785-2419
Practice Address - Country:US
Practice Address - Phone:240-677-3100
Practice Address - Fax:301-851-5600
Is Sole Proprietor?:No
Enumeration Date:2025-04-04
Last Update Date:2025-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program