Provider Demographics
NPI:1578945341
Name:MOHIUDDIN, AYESHA (DPM)
Entity Type:Individual
Prefix:DR
First Name:AYESHA
Middle Name:
Last Name:MOHIUDDIN
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:DR
Other - First Name:AYESHA
Other - Middle Name:
Other - Last Name:MOHIUDDIN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DPM
Mailing Address - Street 1:25 WASHINGTON AVE
Mailing Address - Street 2:UNIT 2
Mailing Address - City:LYNBROOK
Mailing Address - State:NY
Mailing Address - Zip Code:11563-2723
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:25 WASHINGTON AVE
Practice Address - Street 2:UNIT 2
Practice Address - City:LYNBROOK
Practice Address - State:NY
Practice Address - Zip Code:11563-2723
Practice Address - Country:US
Practice Address - Phone:630-945-6016
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-29
Last Update Date:2015-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MD00324000213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery