Healthcare Provider Details

I. General information

NPI: 1053226472
Provider Name (Legal Business Name): AYESHA JOHAR
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/18/2026
Last Update Date: 08/18/2026
Certification Date: 08/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4421 SUN N LAKE BLVD
SEBRING FL
33872-2166
US

IV. Provider business mailing address

4421 SUN N LAKE BLVD STE B
SEBRING FL
33872-2172
US

V. Phone/Fax

Practice location:
  • Phone: 916-873-0575
  • Fax:
Mailing address:
  • Phone: 916-873-0575
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QB0505X
TaxonomyDiabetology (Internal Medicine) Physician
License Number46623
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: