Healthcare Provider Details

I. General information

NPI: 1528661402
Provider Name (Legal Business Name): ALYSSA VENTURA PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: ALYSSA MELONE PA-C

II. Dates (important events)

Enumeration Date: 11/21/2020
Last Update Date: 08/04/2026
Certification Date: 08/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1617 OWEN DR
FAYETTEVILLE NC
28304-3425
US

IV. Provider business mailing address

1613 OWEN DR STE B
FAYETTEVILLE NC
28304-3425
US

V. Phone/Fax

Practice location:
  • Phone: 910-491-8934
  • Fax: 910-491-7119
Mailing address:
  • Phone: 910-491-8934
  • Fax: 910-491-7119

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number0010-12713
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number0010-12713
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: