Provider Demographics
NPI:1386271526
Name:MOBEEN, AYESHA
Entity type:Individual
Prefix:
First Name:AYESHA
Middle Name:
Last Name:MOBEEN
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 1:307 SUMMIT RIDGE CIR
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37215-3806
Mailing Address - Country:US
Mailing Address - Phone:413-356-8941
Mailing Address - Fax:
Practice Address - Street 1:750 OLD HICKORY BLVD
Practice Address - Street 2:
Practice Address - City:BRENTWOOD
Practice Address - State:TN
Practice Address - Zip Code:37027-4528
Practice Address - Country:US
Practice Address - Phone:615-371-6106
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-26
Last Update Date:2020-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN246ZE0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes246ZE0500XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherEEGGroup - Multi-Specialty