Healthcare Provider Details

I. General information

NPI: 1750141834
Provider Name (Legal Business Name): AYESHA USMAN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/19/2024
Last Update Date: 03/19/2024
Certification Date: 03/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

355 BARD AVE
STATEN ISLAND NY
10310-1664
US

IV. Provider business mailing address

70 CONSTITUTION AVE # APTT211
PORTSMOUTH NH
03801-5985
US

V. Phone/Fax

Practice location:
  • Phone: 718-818-4636
  • Fax:
Mailing address:
  • Phone: 203-989-6522
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: