Provider Demographics
NPI:1316241649
Name:KHAN, SHAMINA (PA)
Entity type:Individual
Prefix:
First Name:SHAMINA
Middle Name:
Last Name:KHAN
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:9165 W THUNDERBIRD RD STE 101
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85381-4847
Mailing Address - Country:US
Mailing Address - Phone:623-249-2100
Mailing Address - Fax:623-476-7305
Practice Address - Street 1:9165 W THUNDERBIRD RD STE 101
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85381-4847
Practice Address - Country:US
Practice Address - Phone:623-249-2100
Practice Address - Fax:623-476-7305
Is Sole Proprietor?:No
Enumeration Date:2010-12-30
Last Update Date:2025-10-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AZ4730363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant