Provider Demographics
NPI:1194865816
Name:FLETCHER, NEYSHA MICHEALA-ALITHE (PA)
Entity Type:Individual
Prefix:MS
First Name:NEYSHA
Middle Name:MICHEALA-ALITHE
Last Name:FLETCHER
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3823 FOSTER AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11203-5630
Mailing Address - Country:US
Mailing Address - Phone:718-462-3962
Mailing Address - Fax:718-462-3962
Practice Address - Street 1:506 MALCOLM X BLVD
Practice Address - Street 2:MLK PAV., 17TH FLOOR, RM 17101
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10037-1802
Practice Address - Country:US
Practice Address - Phone:212-939-4001
Practice Address - Fax:212-939-4015
Is Sole Proprietor?:No
Enumeration Date:2007-02-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY006716-1363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical