MEDICARE: ASEEYAH AMBREEN ISLAM

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
1	390200000X	Student in an Organized Health Care Education/Training Program

General Provider Information

NPI Number	:	1558164228
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ASEEYAH AMBREEN ISLAM

Provider Business Mailing Address
First Line	:	3260 ROYAL CREEK WAY SW
Second Line	:
City	:	LILBURN
State	:	GA
Zip	:	30047-1886
Country	:	US
Telephone Number	:	404-547-6673
Fax Number	:

Provider Business Practice Location Address
First Line	:	6625 CLAYTON AVE APT 216
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63139-3364
Country	:	US
Telephone Number	:	404-547-6673
Fax Number	:

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

Provider Enumeration Date	:	03/28/2025
Last Update Date	:	03/28/2025

Similar Medicare Providers

1821271024 — ALLCARE HEALTH & HUMAN SERVICES, INC
Practice Location Address:

3364 SW CRESTVIEW RD
PORT SAINT LUCIE, FL
34953-3538

Practice Phone: 772-785-5102
Practice Fax: 772-785-6090

1437480712 — BOGEY HILLS DENTAL LLC
Practice Location Address:

1008 COUNTRY CLUB RD
SAINT CHARLES, MO
63303-3364

Practice Phone: 636-946-0767
Practice Fax: 636-946-0772

1508127929 — DR. BRANDON POLLARD DDS
Practice Location Address:

1008 COUNTRY CLUB RD
SAINT CHARLES, MO
63303-3364

Practice Phone: 636-946-0767
Practice Fax:

1568915551 — KATHLEEN STANLEY M.A., CCC-SLP
Practice Location Address:

20925 LAKELAND ST
SAINT CLAIR SHORES, MI
48081-3364

Practice Phone: 586-405-5354
Practice Fax:

1811655913 — DUCK FALLS COUNSELING AND WELLNESS LLC
Practice Location Address:

1018 COUNTRY CLUB RD
SAINT CHARLES, MO
63303-3364

Practice Phone: 314-471-4445
Practice Fax:

1629798525 — SELENA MIREYA GARZA MSW
Practice Location Address:

824 HALL AVE
SAINT PAUL, MN
55107-3364

Practice Phone: 701-740-1397
Practice Fax:

Directions to “ ASEEYAH AMBREEN ISLAM ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.