Provider Demographics
NPI:1245891969
Name:WILEY, LASHAY NADJAH
Entity type:Individual
Prefix:
First Name:LASHAY
Middle Name:NADJAH
Last Name:WILEY
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 1:527 TIMBERLAKE RD
Mailing Address - Street 2:
Mailing Address - City:UPPER DARBY
Mailing Address - State:PA
Mailing Address - Zip Code:19082-5001
Mailing Address - Country:US
Mailing Address - Phone:267-333-5415
Mailing Address - Fax:
Practice Address - Street 1:527 TIMBERLAKE RD
Practice Address - Street 2:
Practice Address - City:UPPER DARBY
Practice Address - State:PA
Practice Address - Zip Code:19082-5001
Practice Address - Country:US
Practice Address - Phone:267-333-5415
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-24
Last Update Date:2019-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide