Provider Demographics
NPI:1922479443
Name:AIYANA, JULIETTE (LAC)
Entity Type:Individual
Prefix:
First Name:JULIETTE
Middle Name:
Last Name:AIYANA
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:222 E 17TH ST APT 3M
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11226-4643
Mailing Address - Country:US
Mailing Address - Phone:917-676-3265
Mailing Address - Fax:
Practice Address - Street 1:32 UNION SQ E
Practice Address - Street 2:SUITE 615 NORTH
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10003-3209
Practice Address - Country:US
Practice Address - Phone:646-504-2251
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-09
Last Update Date:2015-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY001874-1171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist