Provider Demographics
NPI:1639272131
Name:JAFRI, AYESHA (MD)
Entity Type:Individual
Prefix:DR
First Name:AYESHA
Middle Name:
Last Name:JAFRI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4029 STAFFORDSHIRE DR
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33809-4072
Mailing Address - Country:US
Mailing Address - Phone:240-401-9937
Mailing Address - Fax:
Practice Address - Street 1:4029 STAFFORDSHIRE DR
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33809-4072
Practice Address - Country:US
Practice Address - Phone:240-401-9937
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-07
Last Update Date:2020-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD60526207Q00000X
FLME124493207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
012157W05Medicare ID - Type Unspecified
MD402952600Medicaid
G25403Medicare UPIN