Provider Demographics
NPI:1215009352
Name:KHAN, SHERYL L (RPA)
Entity type:Individual
Prefix:
First Name:SHERYL
Middle Name:L
Last Name:KHAN
Suffix:
Gender:F
Credentials:RPA
Other - Prefix:
Other - First Name:SHERYL
Other - Middle Name:L
Other - Last Name:ANDERSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:510 TOWNE DR
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:13066-1331
Mailing Address - Country:US
Mailing Address - Phone:315-663-0500
Mailing Address - Fax:315-663-0514
Practice Address - Street 1:510 TOWNE DR
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NY
Practice Address - Zip Code:13066-1331
Practice Address - Country:US
Practice Address - Phone:315-663-0500
Practice Address - Fax:315-663-0514
Is Sole Proprietor?:No
Enumeration Date:2006-11-14
Last Update Date:2019-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY005681-1363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02870024Medicaid
PA2430Medicare PIN
PA2430Medicare PIN