Provider Demographics
NPI:1639574775
Name:GRAY, AYISHA E
Entity Type:Individual
Prefix:
First Name:AYISHA
Middle Name:E
Last Name:GRAY
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 1:4823 SILVER STAR RD
Mailing Address - Street 2:STE. 1702
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32808-4967
Mailing Address - Country:US
Mailing Address - Phone:407-431-0766
Mailing Address - Fax:
Practice Address - Street 1:594 CALIBRE CREST PKWY APT 203
Practice Address - Street 2:
Practice Address - City:ALTAMONTE SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:32714-3640
Practice Address - Country:US
Practice Address - Phone:321-972-6067
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-31
Last Update Date:2014-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator