MEDICARE: AYANA CYKIA NELSON

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
1	251E00000X	Home Health Agency	PHCP042949	GA

General Provider Information

NPI Number	:	1538950217
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AYANA CYKIA NELSON

Provider Business Mailing Address
First Line	:	957 POPLAR SPRINGS RD APT 1H
Second Line	:
City	:	RIVERDALE
State	:	GA
Zip	:	30274-1659
Country	:	US
Telephone Number	:	404-858-7617
Fax Number	:

Provider Business Practice Location Address
First Line	:	957 POPLAR SPRINGS RD APT 1H
Second Line	:
City	:	RIVERDALE
State	:	GA
Zip	:	30274-1659
Country	:	US
Telephone Number	:	404-858-7617
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/13/2025
Last Update Date	:	05/13/2025

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