Healthcare Provider Details

I. General information

NPI: 1013399856
Provider Name (Legal Business Name): AYESHA JAMEEL MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/28/2015
Last Update Date: 10/03/2025
Certification Date: 10/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1708 YAKIMA AVE STE 205
TACOMA WA
98405-5300
US

IV. Provider business mailing address

1708 YAKIMA AVE STE 205
TACOMA WA
98405-5300
US

V. Phone/Fax

Practice location:
  • Phone: 253-565-6777
  • Fax: 253-566-8777
Mailing address:
  • Phone: 253-565-6777
  • Fax: 253-566-8777

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number29456
License Number StateWV
# 2
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License NumberMD70000360
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: