Provider Demographics
NPI:1417754557
Name:FASANO, ALYSSA (MS, MA, CGC)
Entity type:Individual
Prefix:
First Name:ALYSSA
Middle Name:
Last Name:FASANO
Suffix:
Gender:
Credentials:MS, MA, CGC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6950 DEER RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:MAUMEE
Mailing Address - State:OH
Mailing Address - Zip Code:43537-9804
Mailing Address - Country:US
Mailing Address - Phone:567-876-2046
Mailing Address - Fax:
Practice Address - Street 1:2500 METROHEALTH DR # G730A
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44109-1900
Practice Address - Country:US
Practice Address - Phone:216-778-7481
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-26
Last Update Date:2025-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH70.000910170300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes170300000XOther Service ProvidersGenetic Counselor, MS