Provider Demographics
NPI:1306301510
Name:AHMED, AIYSHA (MS, RD, CDE)
Entity type:Individual
Prefix:MRS
First Name:AIYSHA
Middle Name:
Last Name:AHMED
Suffix:
Gender:F
Credentials:MS, RD, CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6334 JARVIS AVE
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:CA
Mailing Address - Zip Code:94560-1246
Mailing Address - Country:US
Mailing Address - Phone:510-375-3535
Mailing Address - Fax:
Practice Address - Street 1:20 HAROLD AVE STE C4
Practice Address - Street 2:
Practice Address - City:SANTA CLARA
Practice Address - State:CA
Practice Address - Zip Code:95050-2067
Practice Address - Country:US
Practice Address - Phone:510-375-3535
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-01
Last Update Date:2019-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1087919133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty