MEDICARE: AALIYAH FANTROY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	367500000X	Certified Registered Nurse Anesthetist	1-162500	AL
2	367500000X	Certified Registered Nurse Anesthetist	31733	SC

General Provider Information

NPI Number	:	1245994607
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AALIYAH FANTROY

Provider Business Mailing Address
First Line	:	5779 DARIEN DR
Second Line	:
City	:	MONTGOMERY
State	:	AL
Zip	:	36117-3046
Country	:	US
Telephone Number	:	334-233-0352
Fax Number	:

Provider Business Practice Location Address
First Line	:	5779 DARIEN DR
Second Line	:
City	:	MONTGOMERY
State	:	AL
Zip	:	36117-3046
Country	:	US
Telephone Number	:	334-233-0352
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/22/2021
Last Update Date	:	06/04/2026

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Directions to “ AALIYAH FANTROY ” Practice Location

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