Provider Demographics
NPI:1316693021
Name:DESHAZO, ALYSHA
Entity type:Individual
Prefix:
First Name:ALYSHA
Middle Name:
Last Name:DESHAZO
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 1:7529 LANDSWORTH AVE
Mailing Address - Street 2:
Mailing Address - City:HENRICO
Mailing Address - State:VA
Mailing Address - Zip Code:23228-4718
Mailing Address - Country:US
Mailing Address - Phone:804-263-4242
Mailing Address - Fax:
Practice Address - Street 1:7529 LANDSWORTH AVE
Practice Address - Street 2:
Practice Address - City:HENRICO
Practice Address - State:VA
Practice Address - Zip Code:23228-4718
Practice Address - Country:US
Practice Address - Phone:804-263-4242
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-22
Last Update Date:2022-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst