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NPI Code Detail

MEDICARE: AYESHA FONSECA-POLINENI MD

MEDICARE: AYESHA FONSECA-POLINENI MD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1390200000XStudent in an Organized Health Care Education/Training ProgramML70134521WA

General Provider Information

NPI Number : 1386537041
Entity Type Code : Individual
Provider Name (Legal Business Name) : AYESHA FONSECA-POLINENI MD
Provider Business Mailing Address
First Line : 501 S 5TH AVE
Second Line :
City : YAKIMA
State : WA
Zip : 98902-3550
Country : US
Telephone Number : 509-853-1082
Fax Number :
Provider Business Practice Location Address
First Line : 1 BROOKDALE PLZ
Second Line :
City : BROOKLYN
State : NY
Zip : 11212-3139
Country : US
Telephone Number : 718-240-5000
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/02/2025
Last Update Date : 06/11/2026

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