Provider Demographics
NPI:1083439103
Name:LYONS, ALYSSA (PA-C)
Entity type:Individual
Prefix:
First Name:ALYSSA
Middle Name:
Last Name:LYONS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:230 E 20TH ST APT 55
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10003-1851
Mailing Address - Country:US
Mailing Address - Phone:732-557-1370
Mailing Address - Fax:
Practice Address - Street 1:224 W 18TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10011-4556
Practice Address - Country:US
Practice Address - Phone:646-346-8809
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-11-22
Last Update Date:2024-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MP00861000363A00000X
NY032005363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant