Provider Demographics
NPI:1568294759
Name:KHAN, WAASAY HASSAN
Entity type:Individual
Prefix:
First Name:WAASAY
Middle Name:HASSAN
Last Name:KHAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:50 PRESIDENTIAL PLZ APT 714
Mailing Address - Street 2:
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13202-2275
Mailing Address - Country:US
Mailing Address - Phone:315-760-0286
Mailing Address - Fax:
Practice Address - Street 1:50 PRESIDENTIAL PLZ APT 714
Practice Address - Street 2:
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13202-2275
Practice Address - Country:US
Practice Address - Phone:315-760-0286
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-15
Last Update Date:2024-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training ProgramGroup - Single Specialty