Healthcare Provider Details

I. General information

NPI: 1134877319
Provider Name (Legal Business Name): ALYSSA MARIE VASSALLO MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/16/2022
Last Update Date: 04/28/2023
Certification Date: 04/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 E WENDOVER AVE STE 400
GREENSBORO NC
27401-1207
US

IV. Provider business mailing address

PEDIATRIC EDUCATION OFFICE CAMPUS BOX 7593
CHAPEL HILL NC
27599-7593
US

V. Phone/Fax

Practice location:
  • Phone: 336-832-3150
  • Fax:
Mailing address:
  • Phone:
  • 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 State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: