Healthcare Provider Details

I. General information

NPI: 1588584254
Provider Name (Legal Business Name): HALEY ALYSSA MCMINN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/21/2026
Last Update Date: 07/21/2026
Certification Date: 07/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4511 NE COUNTY ROAD 219A
MELROSE FL
32666-6027
US

IV. Provider business mailing address

6045 COUNTY ROAD 315C
KEYSTONE HEIGHTS FL
32656-7788
US

V. Phone/Fax

Practice location:
  • Phone: 352-776-6140
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: