Healthcare Provider Details

I. General information

NPI: 1518771385
Provider Name (Legal Business Name): AISHA SHAMI AGNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/03/2025
Last Update Date: 02/03/2025
Certification Date: 02/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3771 NESCONSET HWY STE 105
SOUTH SETAUKET NY
11720-1155
US

IV. Provider business mailing address

3771 NESCONSET HWY
SOUTH SETAUKET NY
11720-1163
US

V. Phone/Fax

Practice location:
  • Phone: 631-675-6474
  • Fax:
Mailing address:
  • Phone: 917-224-8591
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number633531
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number307040
License Number StateNY
# 3
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number307040
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: