Healthcare Provider Details

I. General information

NPI: 1336982933
Provider Name (Legal Business Name): NISREEN ASHA M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/13/2024
Last Update Date: 09/01/2026
Certification Date: 09/01/2026
Deactivation Date: 01/17/2025
Reactivation Date: 02/04/2026

III. Provider practice location address

111 MICHIGAN AVE NW
WASHINGTON DC
20010-2916
US

IV. Provider business mailing address

111 MICHIGAN AVE NW
WASHINGTON DC
20010-2916
US

V. Phone/Fax

Practice location:
  • Phone: 202-467-3611
  • Fax:
Mailing address:
  • Phone: 202-467-3611
  • Fax: 202-476-2864

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0402X
TaxonomyNeurology with Special Qualifications in Child Neurology Physician
License Number600111752
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: