Provider Demographics
NPI:1306549191
Name:ALPHONSE, ASHLEY (CER)
Entity type:Individual
Prefix:
First Name:ASHLEY
Middle Name:
Last Name:ALPHONSE
Suffix:
Gender:F
Credentials:CER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:535 NW 2ND AVE APT 115
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33311-8153
Mailing Address - Country:US
Mailing Address - Phone:954-494-0166
Mailing Address - Fax:
Practice Address - Street 1:535 NW 2ND AVE APT 115
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33311-8153
Practice Address - Country:US
Practice Address - Phone:954-494-0166
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-22
Last Update Date:2023-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COST.0006487235500000X
WAST61333689225500000X
432614235500000X, 246Z00000X
171W00000X, 246ZS0410X, 305S00000X, 374700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171W00000XOther Service ProvidersContractorGroup - Multi-Specialty
No235500000XSpeech, Language and Hearing Service ProvidersSpecialist/Technologist
No225500000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/Technologist
No246Z00000XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, Other
No246ZS0410XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Technologist
No305S00000XManaged Care OrganizationsPoint of Service
No374700000XNursing Service Related ProvidersTechnician