Provider Demographics
NPI:1033839899
Name:MOHAMMED, AASIYA
Entity Type:Individual
Prefix:
First Name:AASIYA
Middle Name:
Last Name:MOHAMMED
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22 E 5TH ST APT REAR
Mailing Address - Street 2:
Mailing Address - City:BLOOMSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17815-2202
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1144 E MAIN ST
Practice Address - Street 2:
Practice Address - City:HEGINS
Practice Address - State:PA
Practice Address - Zip Code:17938-9091
Practice Address - Country:US
Practice Address - Phone:570-682-8143
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-31
Last Update Date:2022-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019.0338861223G0001X
PADS0438701223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice