Provider Demographics
NPI:1962970186
Name:CIMAFONTE, ALYSSA (LAC)
Entity type:Individual
Prefix:
First Name:ALYSSA
Middle Name:
Last Name:CIMAFONTE
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2419 MADEIRA CIR
Mailing Address - Street 2:
Mailing Address - City:WAXHAW
Mailing Address - State:NC
Mailing Address - Zip Code:28173-6227
Mailing Address - Country:US
Mailing Address - Phone:631-681-2580
Mailing Address - Fax:
Practice Address - Street 1:616 NORTH BROOME ST
Practice Address - Street 2:SUITE 103
Practice Address - City:WAXHAW
Practice Address - State:NC
Practice Address - Zip Code:28173
Practice Address - Country:US
Practice Address - Phone:631-403-7689
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-06
Last Update Date:2023-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY006400171100000X
NCLAC-2154171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist