Healthcare Provider Details

I. General information

NPI: 1093459547
Provider Name (Legal Business Name): DR. AYESHA ISSINA IBRAHIM YAKUBU
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/21/2022
Last Update Date: 07/02/2026
Certification Date: 07/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1755 N MECKLENBURG AVE
SOUTH HILL VA
23970-4080
US

IV. Provider business mailing address

PO BOX 780125
PHILADELPHIA PA
19178-0125
US

V. Phone/Fax

Practice location:
  • Phone: 434-584-5567
  • Fax: 434-584-5545
Mailing address:
  • Phone: 804-922-4844
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number0101288436
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: