MEDICARE: ASYA B BUSSIE

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number State
1	103TA0700X	Adult Development & Aging Psychologist
2	251C00000X	Developmentally Disabled Services Day Training Agency
3	261QA0600X	Adult Day Care Clinic/Center	MD

General Provider Information

NPI Number	:	1396236790
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ASYA B BUSSIE

Provider Business Mailing Address
First Line	:	3202 BLENHEIM RD
Second Line	:
City	:	PHOENIX
State	:	MD
Zip	:	21131-2228
Country	:	US
Telephone Number	:	443-629-0696
Fax Number	:

Provider Business Practice Location Address
First Line	:	2622 LORD BALTIMORE DR STE A
Second Line	:
City	:	WINDSOR MILL
State	:	MD
Zip	:	21244-2639
Country	:	US
Telephone Number	:	443-629-0696
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/22/2018
Last Update Date	:	08/07/2019

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Directions to “ ASYA B BUSSIE ” Practice Location

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