Provider Demographics
NPI:1407257058
Name:AZIZ, AIESHA (PA-C)
Entity Type:Individual
Prefix:
First Name:AIESHA
Middle Name:
Last Name:AZIZ
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:305 MEMORIAL MEDICAL PARKWAY SUITE 308
Mailing Address - Street 2:
Mailing Address - City:DAYTONA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32117-5137
Mailing Address - Country:US
Mailing Address - Phone:570-972-8174
Mailing Address - Fax:
Practice Address - Street 1:2435 W BELVEDERE AVE STE 35
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21215-5224
Practice Address - Country:US
Practice Address - Phone:410-601-0900
Practice Address - Fax:410-601-0901
Is Sole Proprietor?:No
Enumeration Date:2014-09-12
Last Update Date:2020-02-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLPA9110354363AS0400X
NY017923363AS0400X
MDC07103363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical