Individual provider Active NPI

Aishia Symone Wall, NP

  • Family Nurse Practitioner
  • Fairport, NY
National Provider Identifier
1790331981
Registry record updated Aug 16, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
352346 Issued in NY
Practice address
41 Oconnor Rd
Fairport, NY 14450-1327
Phone
(585) 383-2216
NPI assigned
Aug 13, 2019
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 16, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 352346 NY Primary
Registered Nurse 163W00000X 747632 NY

Addresses

Primary practice location

41 Oconnor Rd
Fairport, NY 14450-1327

Mailing address

41 Oconnor Rd
Fairport, NY 14450-1327

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file
Eligible to order & refer
  • Part B services: No
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
747632NYMDRegistered Nurse
352346NYMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
The Frederick Ferris Thompson Hospital CurrentSince Nov 6, 2023 Accepting new patients
The Frederick Ferris Thompson Hospital CurrentSince Nov 6, 2023 Accepting new patients

Locations

73 Buffalo St
Ste 100
Canandaigua, NY 14424

15 Canandaigua St
Shortsville, NY 14548
Phone (585) 289-3560

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1565654400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1723766400000",
    "number": "1790331981",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "41 OCONNOR RD",
            "city": "FAIRPORT",
            "state": "NY",
            "postal_code": "144501327"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "41 OCONNOR RD",
            "city": "FAIRPORT",
            "state": "NY",
            "postal_code": "144501327",
            "telephone_number": "585-383-2216"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALL",
        "first_name": "AISHIA",
        "middle_name": "SYMONE",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-08-13",
        "last_updated": "2024-08-16",
        "certification_date": "2024-08-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "NY",
            "license": "352346",
            "primary": true
        },
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "NY",
            "license": "747632",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fairport, NY

Sources for this page

Verify at the official NPI Registry.