Provider Demographics
NPI:1346438082
Name:PILLAI, AYESHA SUSAN (MS)
Entity Type:Individual
Prefix:MS
First Name:AYESHA
Middle Name:SUSAN
Last Name:PILLAI
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8335 FREEDOM CROSSING TRL
Mailing Address - Street 2:APT # 3006
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32256-1226
Mailing Address - Country:US
Mailing Address - Phone:904-315-7038
Mailing Address - Fax:
Practice Address - Street 1:1110 EDGEWOOD AVE W
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32208-6405
Practice Address - Country:US
Practice Address - Phone:904-924-1550
Practice Address - Fax:904-924-1544
Is Sole Proprietor?:No
Enumeration Date:2007-10-09
Last Update Date:2007-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health