Healthcare Provider Details

I. General information

NPI: 1184595290
Provider Name (Legal Business Name): ASHLYNE NICKY MEJIA NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/13/2025
Last Update Date: 09/13/2025
Certification Date: 09/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

486 N MAPLE AVE APT 1
EAST ORANGE NJ
07017-4619
US

IV. Provider business mailing address

486 N MAPLE AVE APT 1
EAST ORANGE NJ
07017-4619
US

V. Phone/Fax

Practice location:
  • Phone: 570-618-4520
  • Fax:
Mailing address:
  • Phone: 570-618-4520
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number26NJ15413800
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: