Provider Demographics
NPI:1295543684
Name:JESI, NUSRAT JAHAN (MD)
Entity type:Individual
Prefix:
First Name:NUSRAT
Middle Name:JAHAN
Last Name:JESI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4483 BLOOMFIELD DR
Mailing Address - Street 2:
Mailing Address - City:STERLING HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48310-3313
Mailing Address - Country:US
Mailing Address - Phone:586-480-7776
Mailing Address - Fax:
Practice Address - Street 1:425 BEACH AVE
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14612-2011
Practice Address - Country:US
Practice Address - Phone:586-480-7776
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-12-18
Last Update Date:2024-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYP132869207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine