Provider Demographics
NPI:1528689338
Name:ACEVEDO SANCHEZ, AISHA M
Entity type:Individual
Prefix:
First Name:AISHA
Middle Name:M
Last Name:ACEVEDO SANCHEZ
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 1:2200 S BAY ST STE A
Mailing Address - Street 2:
Mailing Address - City:EUSTIS
Mailing Address - State:FL
Mailing Address - Zip Code:32726-6334
Mailing Address - Country:US
Mailing Address - Phone:407-433-0993
Mailing Address - Fax:
Practice Address - Street 1:2200 S BAY ST STE A
Practice Address - Street 2:
Practice Address - City:EUSTIS
Practice Address - State:FL
Practice Address - Zip Code:32726-6334
Practice Address - Country:US
Practice Address - Phone:407-433-0993
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-04
Last Update Date:2024-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLF02201105363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily