Provider Demographics
NPI:1306434717
Name:REID, NIMAT AYANA
Entity type:Individual
Prefix:
First Name:NIMAT
Middle Name:AYANA
Last Name:REID
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 1:725 GARDEN ST APT 7A
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10457-1914
Mailing Address - Country:US
Mailing Address - Phone:347-912-7648
Mailing Address - Fax:
Practice Address - Street 1:725 GARDEN ST APT 7A
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10457-1914
Practice Address - Country:US
Practice Address - Phone:347-912-7648
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-02
Last Update Date:2021-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker