Individual
JAMILAH AISHA BRODERICK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
5501 FORTUNES RIDGE DR STE P, DURHAM, NC 27713-6102
(919) 391-7202
(919) 391-7203
Mailing address
5501 FORTUNES RIDGE DR STE P, DURHAM, NC 27713-6102
(919) 391-7202
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
0010-11519
NC
363A00000X
Physician Assistant
—
—
Other
Enumeration date
10/25/2021
Last updated
01/30/2025
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