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NPI Code Detail

MEDICARE: MISS AESHA WORRELL

MEDICARE: MISS AESHA WORRELL
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1174400000XSpecialistNY

General Provider Information

NPI Number : 1316683113
Entity Type Code : Individual
Provider Name (Legal Business Name) : MISS AESHA WORRELL
Provider Business Mailing Address
First Line : 100 S WOOD AVE APT 419
Second Line :
City : LINDEN
State : NJ
Zip : 07036-3364
Country : US
Telephone Number : 908-374-4653
Fax Number :
Provider Business Practice Location Address
First Line : 1250 HYLAN BLVD STE 9B1
Second Line :
City : STATEN ISLAND
State : NY
Zip : 10305-1945
Country : US
Telephone Number : 917-397-8947
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/05/2022
Last Update Date : 05/05/2022

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Directions to “ MISS AESHA WORRELL ” Practice Location

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