Provider Demographics
NPI:1528719242
Name:MUSHEFF, ALYSSA MICHELLE ELILAI (PA-C)
Entity type:Individual
Prefix:
First Name:ALYSSA
Middle Name:MICHELLE ELILAI
Last Name:MUSHEFF
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 1:6300 HARRY HINES BLVD FL 7
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75235-5259
Mailing Address - Country:US
Mailing Address - Phone:214-590-5536
Mailing Address - Fax:
Practice Address - Street 1:6300 HARRY HINES BLVD FL 7
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75235-5259
Practice Address - Country:US
Practice Address - Phone:214-590-5536
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-13
Last Update Date:2022-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
STUDENT363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant