Active NPI
Aishia Symone Wall, NP
- Family Nurse Practitioner
- Fairport, NY
National Provider Identifier
1790331981
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Nurse Practitioner
- License
- 352346
- 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
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| 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
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 747632 | NY | MD | Registered Nurse |
| 352346 | NY | MD | Family Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| The Frederick Ferris Thompson Hospital | Current | Accepting new patients | |
| The Frederick Ferris Thompson Hospital | Current | 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.
-
- General Acute Care Hospital
- Canandaigua, NY
- NPI 1194776351
-
- Community/Retail Pharmacy
- Victor, NY
- NPI 1831914274
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
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 16, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.