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Individual

AYESHA MANNAN

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
DO

Contact information

Practice address
515 BROADWAY, MASSAPEQUA, NY 11758-5005
(631) 667-0388
(631) 968-7705
Mailing address
1000 MONTAUK HWY, WEST ISLIP, NY 11795-4927
(631) 376-3420

Taxonomy

Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
308856
NY
390200000X
Student in an Organized Health Care Education/Training Program

Other

Enumeration date
04/23/2018
Last updated
06/23/2021
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