Provider Demographics
NPI:1063950251
Name:STILES, ALYSSA MARIE
Entity type:Individual
Prefix:MRS
First Name:ALYSSA
Middle Name:MARIE
Last Name:STILES
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 1:401 SHADY AVE # G-100
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15206-4409
Mailing Address - Country:US
Mailing Address - Phone:412-407-2668
Mailing Address - Fax:
Practice Address - Street 1:401 SHADY AVE # G-100
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15206-4409
Practice Address - Country:US
Practice Address - Phone:412-407-2668
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-02-07
Last Update Date:2021-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADH071760124Q00000X
PAPHDH000970124Q00000X
PADHA002013124Q00000X
PAMSG013114225700000X
174400000X
PADF004742126800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
No124Q00000XDental ProvidersDental Hygienist
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
No126800000XDental ProvidersDental Assistant