Healthcare Provider Details

I. General information

NPI: 1073347613
Provider Name (Legal Business Name): DIAMOND ALEXIS WYCHE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/27/2024
Last Update Date: 07/08/2025
Certification Date: 07/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

260 MARINER BLVD.
SPRING HILL FL
34609
US

IV. Provider business mailing address

260 MARINER BLVD.
SPRING HILL FL
34609
US

V. Phone/Fax

Practice location:
  • Phone: 609-923-5814
  • Fax:
Mailing address:
  • Phone: 609-923-5814
  • 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: