Provider Demographics
NPI:1962913749
Name:AHMAD, AFSHAN JABEEN
Entity type:Individual
Prefix:
First Name:AFSHAN
Middle Name:JABEEN
Last Name:AHMAD
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 1:58 SAINT MARKS PL APT 610
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11217-5183
Mailing Address - Country:US
Mailing Address - Phone:949-259-3182
Mailing Address - Fax:
Practice Address - Street 1:58 SAINT MARKS PL
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11217-5176
Practice Address - Country:US
Practice Address - Phone:949-259-3182
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-10-19
Last Update Date:2025-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA86013945133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered