Provider Demographics
NPI:1356889174
Name:DELFAUS, AISHA (PMHNP-BC)
Entity type:Individual
Prefix:
First Name:AISHA
Middle Name:
Last Name:DELFAUS
Suffix:
Gender:F
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:140 CASALS PL
Mailing Address - Street 2:APT 9D
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10475-3202
Mailing Address - Country:US
Mailing Address - Phone:917-456-7361
Mailing Address - Fax:
Practice Address - Street 1:140 CASALS PL
Practice Address - Street 2:APT 9D
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10475-3202
Practice Address - Country:US
Practice Address - Phone:917-456-7361
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-02-01
Last Update Date:2023-08-20
Deactivation Date:2023-05-15
Deactivation Code:
Reactivation Date:2023-06-06
Provider Licenses
StateLicense IDTaxonomies
NY404756363LP0808X
NY713804163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse