Provider Demographics
NPI:1144710674
Name:AIJAZ, AAYESHA
Entity type:Individual
Prefix:
First Name:AAYESHA
Middle Name:
Last Name:AIJAZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8121 ANALEE AVE
Mailing Address - Street 2:
Mailing Address - City:ROSEDALE
Mailing Address - State:MD
Mailing Address - Zip Code:21237-1609
Mailing Address - Country:US
Mailing Address - Phone:436-916-2074
Mailing Address - Fax:
Practice Address - Street 1:5268 NICHOLSON LN # 188G
Practice Address - Street 2:
Practice Address - City:KENSINGTON
Practice Address - State:MD
Practice Address - Zip Code:20895-1009
Practice Address - Country:US
Practice Address - Phone:517-317-1742
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-10
Last Update Date:2024-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
106S00000X
MDLGP10815101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician