Healthcare Provider Details

I. General information

NPI: 1750210639
Provider Name (Legal Business Name): AYESHA HAQUE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/16/2026
Last Update Date: 05/16/2026
Certification Date: 05/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7102 W OKANOGAN PL
KENNEWICK WA
99336-2341
US

IV. Provider business mailing address

1622 SAGEWOOD ST
RICHLAND WA
99352-7692
US

V. Phone/Fax

Practice location:
  • Phone: 509-460-4230
  • Fax:
Mailing address:
  • Phone: 917-648-5038
  • 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: