Individual
ASHANTI TRENT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
48 FORTE AVE, MEDFORD, NY 11763-4431
(631) 205-3628
Mailing address
48 FORTE AVE, MEDFORD, NY 11763-4431
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
348704
NY
Other
Enumeration date
10/16/2023
Last updated
10/16/2023
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