Provider Demographics
NPI:1710596895
Name:FLOYD, ALYSSA N (PA-C)
Entity type:Individual
Prefix:
First Name:ALYSSA
Middle Name:N
Last Name:FLOYD
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 1:78 OMEGA DR BLDG C
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:DE
Mailing Address - Zip Code:19713-2064
Mailing Address - Country:US
Mailing Address - Phone:302-368-2974
Mailing Address - Fax:302-368-2892
Practice Address - Street 1:78 OMEGA DR BLDG C
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:DE
Practice Address - Zip Code:19713-2064
Practice Address - Country:US
Practice Address - Phone:302-368-2974
Practice Address - Fax:302-368-2892
Is Sole Proprietor?:No
Enumeration Date:2020-07-24
Last Update Date:2020-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC5-0011413363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical