Healthcare Provider Details

I. General information

NPI: 1841163326
Provider Name (Legal Business Name): ALEXANDRA WYLLIE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/29/2025
Last Update Date: 10/24/2025
Certification Date: 09/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

505 WINDY KNOLL DR
MOUNT AIRY MD
21771-6600
US

IV. Provider business mailing address

133 SCHOOLHOUSE RD
SYKESVILLE MD
21784-7132
US

V. Phone/Fax

Practice location:
  • Phone: 240-668-4415
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: