Provider Demographics
NPI:1538640297
Name:AYEVA FORRESTER, SIRINA
Entity Type:Individual
Prefix:
First Name:SIRINA
Middle Name:
Last Name:AYEVA FORRESTER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:60 E 55TH ST APT A12
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11203-2630
Mailing Address - Country:US
Mailing Address - Phone:646-538-8202
Mailing Address - Fax:
Practice Address - Street 1:1310 ROCKAWAY PKWY
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11236-2339
Practice Address - Country:US
Practice Address - Phone:718-272-3300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-22
Last Update Date:2018-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program