Healthcare Provider Details

I. General information

NPI: 1215109509
Provider Name (Legal Business Name): AYESHA S NASIR M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/27/2008
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12341 STRICKLAND RD SUITE 102
RALEIGH NC
27613-1273
US

IV. Provider business mailing address

306 MINTON VALLEY LN
CARY NC
27519-9105
US

V. Phone/Fax

Practice location:
  • Phone: 919-865-8000
  • Fax: 919-865-8020
Mailing address:
  • Phone: 919-865-8000
  • Fax: 919-865-8020

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License Number139328
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number2010-01420
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: