Healthcare Provider Details

I. General information

NPI: 1669293122
Provider Name (Legal Business Name): ALYSA R. HERMAN, MD, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/17/2024
Last Update Date: 08/20/2025
Certification Date: 08/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

135 SAN LORENZO AVE STE 700
CORAL GABLES FL
33146-1876
US

IV. Provider business mailing address

135 SAN LORENZO AVE STE 700
CORAL GABLES FL
33146-1876
US

V. Phone/Fax

Practice location:
  • Phone: 305-444-4979
  • Fax:
Mailing address:
  • Phone: 305-444-4979
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ND0101X
TaxonomyMOHS-Micrographic Surgery Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ALYSA R HERMAN
Title or Position: OWNER / PRESIDENT
Credential: MD
Phone: 305-444-4979