Provider Demographics
NPI:1538185459
Name:MAHMOUD, AYESHA SHABBIR (MD)
Entity type:Individual
Prefix:
First Name:AYESHA
Middle Name:SHABBIR
Last Name:MAHMOUD
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:AYESHA
Other - Middle Name:SHABBIR
Other - Last Name:DAR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:5 MARINE VIEW PLZ
Mailing Address - Street 2:
Mailing Address - City:HOBOKEN
Mailing Address - State:NJ
Mailing Address - Zip Code:07030-5756
Mailing Address - Country:US
Mailing Address - Phone:201-798-1333
Mailing Address - Fax:201-798-5333
Practice Address - Street 1:10 EXCHANGE PL
Practice Address - Street 2:15TH FLOOR
Practice Address - City:JERSEY CITY
Practice Address - State:NJ
Practice Address - Zip Code:07302-3918
Practice Address - Country:US
Practice Address - Phone:201-821-8911
Practice Address - Fax:201-603-6688
Is Sole Proprietor?:No
Enumeration Date:2006-07-14
Last Update Date:2014-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD39033208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN5440412Medicaid
TNI18231Medicare UPIN