Healthcare Provider Details

I. General information

NPI: 1639033814
Provider Name (Legal Business Name): MS. ALLYSON WILEY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/12/2025
Last Update Date: 12/12/2025
Certification Date: 12/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

203 RIDGELY AVE
ANNAPOLIS MD
21401-1303
US

IV. Provider business mailing address

20 CHELSEA CT
ANNAPOLIS MD
21403-1650
US

V. Phone/Fax

Practice location:
  • Phone: 443-433-0462
  • Fax:
Mailing address:
  • Phone: 443-433-0462
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License Number4076079
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: