Provider Demographics
NPI:1265016828
Name:PERRY, AISHA D
Entity Type:Individual
Prefix:
First Name:AISHA
Middle Name:D
Last Name:PERRY
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 1:6201 W OLIVE AVE APT 2150
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85302-4539
Mailing Address - Country:US
Mailing Address - Phone:602-397-8037
Mailing Address - Fax:
Practice Address - Street 1:6201 W OLIVE AVE APT 2150
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85302-4539
Practice Address - Country:US
Practice Address - Phone:602-397-8037
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-10
Last Update Date:2021-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD02076718172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes172A00000XOther Service ProvidersDriverGroup - Single Specialty