Provider Demographics
NPI:1215613591
Name:KHALIFA, RIYANA
Entity type:Individual
Prefix:
First Name:RIYANA
Middle Name:
Last Name:KHALIFA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 MEDICAL CENTER DR STE 210
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01107-1272
Mailing Address - Country:US
Mailing Address - Phone:413-734-4661
Mailing Address - Fax:
Practice Address - Street 1:2 MEDICAL CENTER DR STE 210
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01107-1272
Practice Address - Country:US
Practice Address - Phone:413-734-4661
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-22
Last Update Date:2023-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant