Provider Demographics
NPI:1033382437
Name:KHAN, DONELLA (DPT)
Entity type:Individual
Prefix:MRS
First Name:DONELLA
Middle Name:
Last Name:KHAN
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3924 GLENWOOD RD
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11210-2021
Mailing Address - Country:US
Mailing Address - Phone:718-885-5306
Mailing Address - Fax:347-715-3094
Practice Address - Street 1:3924 GLENWOOD RD
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11210-2021
Practice Address - Country:US
Practice Address - Phone:718-885-5306
Practice Address - Fax:347-715-3094
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-07
Last Update Date:2008-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY026900-1177F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes177F00000XOther Service ProvidersLodging