MEDICARE: ALYSSA ROACH FNP-C

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	363LF0000X	Family Nurse Practitioner	F11250004	MA

General Provider Information

NPI Number	:	1518802842
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALYSSA ROACH FNP-C

Provider Business Mailing Address
First Line	:	34 GORDON ST APT 3
Second Line	:
City	:	QUINCY
State	:	MA
Zip	:	02171-2069
Country	:	US
Telephone Number	:	774-888-8209
Fax Number	:

Provider Business Practice Location Address
First Line	:	34 GORDON ST APT 3
Second Line	:
City	:	QUINCY
State	:	MA
Zip	:	02171-2069
Country	:	US
Telephone Number	:	774-888-8209
Fax Number	:

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

Provider Enumeration Date	:	04/22/2026
Last Update Date	:	04/22/2026

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