Provider Demographics
NPI:1770472599
Name:PRIVITERA, ALISHA ANN (IBCLC)
Entity type:Individual
Prefix:
First Name:ALISHA
Middle Name:ANN
Last Name:PRIVITERA
Suffix:
Gender:F
Credentials:IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5300 PARTRIDGE HL
Mailing Address - Street 2:
Mailing Address - City:GREAT VALLEY
Mailing Address - State:NY
Mailing Address - Zip Code:14741-9671
Mailing Address - Country:US
Mailing Address - Phone:716-983-0797
Mailing Address - Fax:
Practice Address - Street 1:5300 PARTRIDGE HL
Practice Address - Street 2:
Practice Address - City:GREAT VALLEY
Practice Address - State:NY
Practice Address - Zip Code:14741-9671
Practice Address - Country:US
Practice Address - Phone:716-983-0797
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-30
Last Update Date:2025-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYL-319077174N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RN