Provider Demographics
NPI:1992463749
Name:KHAN, SHAHANA (DC)
Entity type:Individual
Prefix:
First Name:SHAHANA
Middle Name:
Last Name:KHAN
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:117 WASHINGTON AVE APT C
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:08094-1890
Mailing Address - Country:US
Mailing Address - Phone:856-262-7234
Mailing Address - Fax:856-629-9226
Practice Address - Street 1:117 WASHINGTON AVE APT C
Practice Address - Street 2:
Practice Address - City:WILLIAMSTOWN
Practice Address - State:NJ
Practice Address - Zip Code:08094-1890
Practice Address - Country:US
Practice Address - Phone:856-262-7234
Practice Address - Fax:856-629-9226
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-29
Last Update Date:2021-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00787300111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor