Provider Demographics
NPI:1649656679
Name:SMITH-ELLIS, AISHA
Entity type:Individual
Prefix:
First Name:AISHA
Middle Name:
Last Name:SMITH-ELLIS
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 1:626 RIVERSIDE DR
Mailing Address - Street 2:6B
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10031-7201
Mailing Address - Country:US
Mailing Address - Phone:914-325-2400
Mailing Address - Fax:
Practice Address - Street 1:175 MEMORIAL HWY
Practice Address - Street 2:STE 2-1
Practice Address - City:NEW ROCHELLE
Practice Address - State:NY
Practice Address - Zip Code:10801-5635
Practice Address - Country:US
Practice Address - Phone:914-235-7530
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-07-31
Last Update Date:2015-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF307359-1363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health