Provider Demographics
NPI:1558164228
Name:ISLAM, ASEEYAH AMBREEN
Entity type:Individual
Prefix:
First Name:ASEEYAH
Middle Name:AMBREEN
Last Name:ISLAM
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3260 ROYAL CREEK WAY SW
Mailing Address - Street 2:
Mailing Address - City:LILBURN
Mailing Address - State:GA
Mailing Address - Zip Code:30047-1886
Mailing Address - Country:US
Mailing Address - Phone:404-547-6673
Mailing Address - Fax:
Practice Address - Street 1:6625 CLAYTON AVE APT 216
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63139-3364
Practice Address - Country:US
Practice Address - Phone:404-547-6673
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-28
Last Update Date:2025-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program