Provider Demographics
NPI:1245482413
Name:ABODESHISHA, FAYROSE FOUAD (RPA-C)
Entity type:Individual
Prefix:
First Name:FAYROSE
Middle Name:FOUAD
Last Name:ABODESHISHA
Suffix:
Gender:F
Credentials:RPA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:331 NEWMAN SPRINGS ROAD
Mailing Address - Street 2:BLDG. 2, SUITE 220
Mailing Address - City:RED BANK
Mailing Address - State:NJ
Mailing Address - Zip Code:07701
Mailing Address - Country:US
Mailing Address - Phone:732-807-0877
Mailing Address - Fax:201-751-1680
Practice Address - Street 1:462 1ST AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016-9196
Practice Address - Country:US
Practice Address - Phone:212-562-3917
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-10-18
Last Update Date:2025-01-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY23 012911363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical