Provider Demographics
NPI:1407430622
Name:KHAN, SHAHNOOR AHMED
Entity type:Individual
Prefix:
First Name:SHAHNOOR
Middle Name:AHMED
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 1:6938 COZYCROFT AVE
Mailing Address - Street 2:
Mailing Address - City:WINNETKA
Mailing Address - State:CA
Mailing Address - Zip Code:91306-3407
Mailing Address - Country:US
Mailing Address - Phone:818-331-9886
Mailing Address - Fax:
Practice Address - Street 1:6938 COZYCROFT AVE
Practice Address - Street 2:
Practice Address - City:WINNETKA
Practice Address - State:CA
Practice Address - Zip Code:91306-3407
Practice Address - Country:US
Practice Address - Phone:818-331-9886
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-12
Last Update Date:2025-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical