Provider Demographics
NPI:1912356668
Name:AYALA, ALYSSA N (PA-C)
Entity type:Individual
Prefix:
First Name:ALYSSA
Middle Name:N
Last Name:AYALA
Suffix:
Gender:
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 1:1 ARCH PL STE 1
Mailing Address - Street 2:
Mailing Address - City:GREENFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01301-2457
Mailing Address - Country:US
Mailing Address - Phone:413-512-5111
Mailing Address - Fax:413-512-5112
Practice Address - Street 1:63 FRENCH KING HWY
Practice Address - Street 2:
Practice Address - City:GREENFIELD
Practice Address - State:MA
Practice Address - Zip Code:01301-1337
Practice Address - Country:US
Practice Address - Phone:413-512-5111
Practice Address - Fax:413-512-5112
Is Sole Proprietor?:No
Enumeration Date:2016-06-03
Last Update Date:2025-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPA6815363A00000X, 363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant