Healthcare Provider Details

I. General information

NPI: 1952233801
Provider Name (Legal Business Name): AISHA-IZALES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/02/2026
Last Update Date: 06/02/2026
Certification Date: 06/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

124 CARRAWAY DR
COLUMBIA SC
29229-8147
US

IV. Provider business mailing address

124 CARRAWAY DR
COLUMBIA SC
29229-8147
US

V. Phone/Fax

Practice location:
  • Phone: 914-557-7615
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: AISHA FULMORE
Title or Position: CEO
Credential:
Phone: 145-777-1387