Provider Demographics
NPI:1518304989
Name:ASHBY, MICHAEL JERMAINE (RN)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:JERMAINE
Last Name:ASHBY
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23515 147TH DR
Mailing Address - Street 2:
Mailing Address - City:ROSEDALE
Mailing Address - State:NY
Mailing Address - Zip Code:11422-3231
Mailing Address - Country:US
Mailing Address - Phone:646-251-2967
Mailing Address - Fax:718-374-6607
Practice Address - Street 1:23515 147TH DR
Practice Address - Street 2:
Practice Address - City:ROSEDALE
Practice Address - State:NY
Practice Address - Zip Code:11422-3231
Practice Address - Country:US
Practice Address - Phone:646-251-2967
Practice Address - Fax:718-374-6607
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-25
Last Update Date:2013-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY22- 628242163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse