Provider Demographics
NPI:1295316891
Name:KHAN, NIKHAT NAFEEZA
Entity type:Individual
Prefix:
First Name:NIKHAT
Middle Name:NAFEEZA
Last Name:KHAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:NIKHAT
Other - Middle Name:NAFEEZA
Other - Last Name:AZAM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:21 WOODLAND ST STE 311
Mailing Address - Street 2:
Mailing Address - City:HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06105-4318
Mailing Address - Country:US
Mailing Address - Phone:860-527-6745
Mailing Address - Fax:860-293-2021
Practice Address - Street 1:21 WOODLAND ST STE 311
Practice Address - Street 2:
Practice Address - City:HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06105-4318
Practice Address - Country:US
Practice Address - Phone:860-527-6745
Practice Address - Fax:860-293-2021
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-16
Last Update Date:2025-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT79254207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine