Healthcare Provider Details

I. General information

NPI: 1740127588
Provider Name (Legal Business Name): AYESHA REHMAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/30/2026
Last Update Date: 04/30/2026
Certification Date: 04/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

736 CAMBRIDGE ST
BRIGHTON MA
02135-2907
US

IV. Provider business mailing address

4800 E INTERSTATE 240 SERVICE ROAD 1513
OKLAHOMA CITY OK
73135
US

V. Phone/Fax

Practice location:
  • Phone: 617-789-2372
  • Fax:
Mailing address:
  • Phone: 626-693-0484
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number3019852
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: