Provider Demographics
NPI:1942221031
Name:LALL, AYESHA SHYIA (MD)
Entity Type:Individual
Prefix:DR
First Name:AYESHA
Middle Name:SHYIA
Last Name:LALL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:AYESHA
Other - Middle Name:SEEMEEN
Other - Last Name:LALL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 918025
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32891-8025
Mailing Address - Country:US
Mailing Address - Phone:352-392-3681
Mailing Address - Fax:352-392-9887
Practice Address - Street 1:1600 SW ARCHER RD
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32610-3003
Practice Address - Country:US
Practice Address - Phone:352-392-8373
Practice Address - Fax:352-846-1455
Is Sole Proprietor?:No
Enumeration Date:2006-07-22
Last Update Date:2008-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME940752084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLI22595Medicare UPIN
FL28757Medicare ID - Type Unspecified
FL28757ZMedicare PIN