Provider Demographics
NPI:1669759841
Name:MATHEWS, ASHA (PA)
Entity type:Individual
Prefix:MRS
First Name:ASHA
Middle Name:
Last Name:MATHEWS
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:360 MERRICK RD FL 1
Mailing Address - Street 2:
Mailing Address - City:LYNBROOK
Mailing Address - State:NY
Mailing Address - Zip Code:11563-2526
Mailing Address - Country:US
Mailing Address - Phone:516-887-3516
Mailing Address - Fax:516-887-0331
Practice Address - Street 1:360 MERRICK RD FL 1
Practice Address - Street 2:
Practice Address - City:LYNBROOK
Practice Address - State:NY
Practice Address - Zip Code:11563-2526
Practice Address - Country:US
Practice Address - Phone:516-887-3516
Practice Address - Fax:516-887-0331
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-15
Last Update Date:2024-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical