Healthcare Provider Details

I. General information

NPI: 1588430482
Provider Name (Legal Business Name): ALYSSA S BEARDSLEY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/30/2023
Last Update Date: 06/06/2026
Certification Date: 06/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4023 KENNETT PIKE # 988
WILMINGTON DE
19807-2018
US

IV. Provider business mailing address

1980 SUPERFINE LN APT 301
WILMINGTON DE
19802-4924
US

V. Phone/Fax

Practice location:
  • Phone: 484-577-9928
  • Fax:
Mailing address:
  • Phone: 925-914-0527
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number0-26-16951
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: