Basic Information
| Provider Information | |||||||||
| NPI: | 1033737671 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | JAMIL | ||||||||
| FirstName: | AYESHA | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 689 MAGNOLIA CT | ||||||||
| Address2: | |||||||||
| City: | BENSALEM | ||||||||
| State: | PA | ||||||||
| PostalCode: | 190204319 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2673425097 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2601 HOLME AVE | ||||||||
| Address2: | |||||||||
| City: | PHILADELPHIA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 191522096 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2673507403 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/09/2020 | ||||||||
| LastUpdateDate: | 07/09/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 07/09/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | MT220627 | PA | Y | Student, Health Care | Student in an Organized Health Care Education/Training Program |
No ID Information.