Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LG0600X | Nurse Practitioner - Gerontology | 11014724 | FL |
NPI | 1053085621 |
---|---|
Provider Name | Shereen Aysheh |
First Address | Ocala, FL 34476-9345 |
Second Address | Ocala, FL 34476-9345 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/08/2021 |
Last Update Date | 02/09/2021 |