Provider Demographics
NPI:1609580646
Name:HARRIS, ASIYANNA S
Entity Type:Individual
Prefix:
First Name:ASIYANNA
Middle Name:S
Last Name:HARRIS
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 1:8800 COTTAGE ST # 1
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19136-1421
Mailing Address - Country:US
Mailing Address - Phone:267-428-8949
Mailing Address - Fax:
Practice Address - Street 1:8800 COTTAGE ST # 1
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19136-1421
Practice Address - Country:US
Practice Address - Phone:800-552-4943
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-12
Last Update Date:2023-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA70073601385H00000X, 253Z00000X, 376J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes253Z00000XAgenciesIn Home Supportive Care
No385H00000XRespite Care FacilityRespite Care
No376J00000XNursing Service Related ProvidersHomemakerGroup - Single Specialty