Provider Demographics
NPI:1326048752
Name:ANSARI, AAISYA NABEEHAH (MD)
Entity Type:Individual
Prefix:DR
First Name:AAISYA
Middle Name:NABEEHAH
Last Name:ANSARI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:AAISYA
Other - Middle Name:
Other - Last Name:ANSARI-LAWAL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:12709 HALYARD PL
Mailing Address - Street 2:
Mailing Address - City:FORT WASHINGTON
Mailing Address - State:MD
Mailing Address - Zip Code:20744-7041
Mailing Address - Country:US
Mailing Address - Phone:404-915-1996
Mailing Address - Fax:
Practice Address - Street 1:524 W SAGAMORE AVE
Practice Address - Street 2:
Practice Address - City:CLEWISTON
Practice Address - State:FL
Practice Address - Zip Code:33440-3514
Practice Address - Country:US
Practice Address - Phone:863-983-9121
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-28
Last Update Date:2022-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0062574207P00000X
KYC0747207P00000X
FLME132118207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLD58I1OtherBCBS
FL020877800Medicaid