MEDICARE: AISHA A ABDEL-MOTELB FNP

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	164W00000X	Licensed Practical Nurse	302062-1	NY
2	363L00000X	Nurse Practitioner	APRN11027859	FL

General Provider Information

NPI Number	:	1932405339
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AISHA A ABDEL-MOTELB FNP

Provider Business Mailing Address
First Line	:	1480 NW NORTH RIVER DR APT 304
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33125-2868
Country	:	US
Telephone Number	:	315-745-0904
Fax Number	:

Provider Business Practice Location Address
First Line	:	1480 NW NORTH RIVER DR APT 304
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33125-2868
Country	:	US
Telephone Number	:	315-745-0904
Fax Number	:

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

Provider Enumeration Date	:	02/01/2011
Last Update Date	:	06/11/2024

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