Healthcare Provider Details

I. General information

NPI: 1003776220
Provider Name (Legal Business Name): LATISHA EXUM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: LATISHA PATTERSON

II. Dates (important events)

Enumeration Date: 11/12/2025
Last Update Date: 11/12/2025
Certification Date: 11/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3280 SUNRISE HWY
WANTAGH NY
11793-4024
US

IV. Provider business mailing address

3280 SUNRISE HWY
WANTAGH NY
11793-4024
US

V. Phone/Fax

Practice location:
  • Phone: 516-590-7575
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: