Healthcare Provider Details

I. General information

NPI: 1073349262
Provider Name (Legal Business Name): AYESHA C CHIEM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: AYESHA C PRIDE

II. Dates (important events)

Enumeration Date: 09/12/2024
Last Update Date: 12/08/2025
Certification Date: 12/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PO BOX 901
PHILADELPHIA PA
19105-0901
US

IV. Provider business mailing address

PO BOX 901
PHILADELPHIA PA
19105-0901
US

V. Phone/Fax

Practice location:
  • Phone: 267-240-5818
  • Fax:
Mailing address:
  • Phone: 215-509-0295
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberSP030041
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: