Provider Demographics
NPI:1720881170
Name:ALEXANDER, SHYLISA P
Entity type:Individual
Prefix:
First Name:SHYLISA
Middle Name:P
Last Name:ALEXANDER
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1777 REISTERSTOWN RD STE 165R
Mailing Address - Street 2:
Mailing Address - City:PIKESVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21208-1387
Mailing Address - Country:US
Mailing Address - Phone:410-541-1316
Mailing Address - Fax:
Practice Address - Street 1:1777 REISTERSTOWN RD STE 165R165R
Practice Address - Street 2:
Practice Address - City:PIKESVILLE
Practice Address - State:MD
Practice Address - Zip Code:21208-1313
Practice Address - Country:US
Practice Address - Phone:410-541-1316
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-31
Last Update Date:2025-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician