Provider Demographics
NPI:1528544335
Name:ALEXANDER ROBERTSON, QUISHA SHERANE
Entity Type:Individual
Prefix:
First Name:QUISHA
Middle Name:SHERANE
Last Name:ALEXANDER ROBERTSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:QUISHA
Other - Middle Name:SHERANE
Other - Last Name:ALEXANDER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:6120B WOODLAND AVE
Mailing Address - Street 2:FL 2
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19142-3224
Mailing Address - Country:US
Mailing Address - Phone:516-428-5362
Mailing Address - Fax:
Practice Address - Street 1:4700 WISSAHICKON AVE BLDG D
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19144
Practice Address - Country:US
Practice Address - Phone:215-843-9720
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-15
Last Update Date:2020-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP018915363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily