Healthcare Provider Details

I. General information

NPI: 1811851868
Provider Name (Legal Business Name): AYESHA ASSAD MEDICAL PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/15/2025
Last Update Date: 12/15/2025
Certification Date: 12/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8 EVANS DR
GLEN HEAD NY
11545-3145
US

IV. Provider business mailing address

8 EVANS DR
GLEN HEAD NY
11545-3145
US

V. Phone/Fax

Practice location:
  • Phone: 516-314-6965
  • Fax:
Mailing address:
  • Phone: 516-314-6965
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: AYESHA ASSAD
Title or Position: OWNER
Credential: MD
Phone: 516-314-6965