Healthcare Provider Details

I. General information

NPI: 1699578708
Provider Name (Legal Business Name): ALYSSA ROYALTY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/01/2025
Last Update Date: 04/01/2025
Certification Date: 03/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2614 CHARLESTOWN ROAD
NEW ALBANY IN
47150
US

IV. Provider business mailing address

2785 CASON ST
LAFAYETTE IN
47904-2843
US

V. Phone/Fax

Practice location:
  • Phone: 930-204-2414
  • Fax:
Mailing address:
  • Phone: 317-502-3512
  • 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: