Healthcare Provider Details

I. General information

NPI: 1609565977
Provider Name (Legal Business Name): AYESHAH JALID M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/03/2023
Last Update Date: 07/21/2026
Certification Date: 07/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

908 MEMORIAL CT STE 304
ELIZABETHTOWN KY
42701-2562
US

IV. Provider business mailing address

2157 MAIN ST
BUFFALO NY
14214
US

V. Phone/Fax

Practice location:
  • Phone: 270-769-1049
  • Fax:
Mailing address:
  • Phone: 716-862-1000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number62203
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: