Provider Demographics
NPI:1316757081
Name:ELLIOTT, AISHA NYLA-LEE
Entity type:Individual
Prefix:
First Name:AISHA
Middle Name:NYLA-LEE
Last Name:ELLIOTT
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 1:15 DAVENPORT AVE APT 4H
Mailing Address - Street 2:
Mailing Address - City:NEW ROCHELLE
Mailing Address - State:NY
Mailing Address - Zip Code:10805-3429
Mailing Address - Country:US
Mailing Address - Phone:914-268-5861
Mailing Address - Fax:
Practice Address - Street 1:15 DAVENPORT AVE APT 4H
Practice Address - Street 2:
Practice Address - City:NEW ROCHELLE
Practice Address - State:NY
Practice Address - Zip Code:10805-3429
Practice Address - Country:US
Practice Address - Phone:914-268-5861
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-13
Last Update Date:2025-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY350634-01164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse