Provider Demographics
NPI:1982220133
Name:WILLIAMS, AISHA J
Entity Type:Individual
Prefix:
First Name:AISHA
Middle Name:J
Last Name:WILLIAMS
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 1:6097 NW EAST DEVILLE CIR
Mailing Address - Street 2:
Mailing Address - City:PORT ST LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34986-3784
Mailing Address - Country:US
Mailing Address - Phone:772-801-4897
Mailing Address - Fax:
Practice Address - Street 1:6097 NW EAST DEVILLE CIR
Practice Address - Street 2:
Practice Address - City:PORT ST LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34986-3784
Practice Address - Country:US
Practice Address - Phone:772-801-4897
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-24
Last Update Date:2020-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide