Healthcare Provider Details

I. General information

NPI: 1245142181
Provider Name (Legal Business Name): ALYSSA FEDDERLY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/17/2026
Last Update Date: 09/17/2026
Certification Date: 09/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1209 NEWTON AVE
BATAVIA IL
60510-4534
US

IV. Provider business mailing address

1209 NEWTON AVE
BATAVIA IL
60510-4534
US

V. Phone/Fax

Practice location:
  • Phone: 630-229-3124
  • Fax:
Mailing address:
  • Phone: 630-229-3124
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: