Healthcare Provider Details

I. General information

NPI: 1205748159
Provider Name (Legal Business Name): ALYSSIE AMAYA BLYTHE RBT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/17/2026
Last Update Date: 09/17/2026
Certification Date: 09/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13000 N 103RD AVE STE 79
SUN CITY AZ
85351-3060
US

IV. Provider business mailing address

12603 W CAMPINA DR
LITCHFIELD PARK AZ
85340-5500
US

V. Phone/Fax

Practice location:
  • Phone: 602-772-7818
  • Fax: 623-806-8656
Mailing address:
  • Phone: 602-772-7818
  • Fax: 623-806-8656

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-25-418530
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: