Individual
AALIYAH JORDAN BLACK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
21 LIBERTY DR, HEBRON, CT 06248
(860) 228-9300
(860) 228-4703
Mailing address
41 MASSABESIC DR, AUBURN, NH 03032-3167
(860) 228-9300
(860) 228-4703
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
—
—
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
06/04/2024
Last updated
07/02/2026
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