Healthcare Provider Details

I. General information

NPI: 1942115985
Provider Name (Legal Business Name): ALESYA M WILLARD MA69645
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/15/2026
Last Update Date: 08/15/2026
Certification Date: 08/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

321 N MANGOUSTINE AVE
SANFORD FL
32771-1098
US

IV. Provider business mailing address

321 N MANGOUSTINE AVE
SANFORD FL
32771-1098
US

V. Phone/Fax

Practice location:
  • Phone: 407-539-3950
  • Fax:
Mailing address:
  • Phone: 407-539-3950
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMA69645
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: