Provider Demographics
NPI:1922597814
Name:AHAMED, AYAH
Entity Type:Individual
Prefix:DR
First Name:AYAH
Middle Name:
Last Name:AHAMED
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 1:86 LYCEUM CT
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10310-2356
Mailing Address - Country:US
Mailing Address - Phone:646-361-4784
Mailing Address - Fax:
Practice Address - Street 1:242 MASON AVE STE 5
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10305-3408
Practice Address - Country:US
Practice Address - Phone:718-226-6919
Practice Address - Fax:718-226-6197
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-07
Last Update Date:2021-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYTUV008841152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist