Healthcare Provider Details

I. General information

NPI: 1295470680
Provider Name (Legal Business Name): AISHA SYNCLAIR JAMISON MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/01/2022
Last Update Date: 05/25/2026
Certification Date: 05/25/2026
Deactivation Date: 04/03/2023
Reactivation Date: 05/26/2023

III. Provider practice location address

1959 NE PACIFIC STREET BB-1332 BOX 356524
SEATTLE WA
98195-6524
US

IV. Provider business mailing address

1959 NE PACIFIC STREET BB-1332 BOX 356524
SEATTLE WA
98195-6524
US

V. Phone/Fax

Practice location:
  • Phone: 206-685-6120
  • Fax:
Mailing address:
  • Phone: 206-685-6120
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberMDRE.ML.61540454
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberMDRE.ML.61540454
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: