Healthcare Provider Details

I. General information

NPI: 1275252579
Provider Name (Legal Business Name): ALLYSON JOANN DIMELLA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/22/2022
Last Update Date: 09/29/2025
Certification Date: 09/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

44 SHUCKIN ST UNIT 105
HAMPSTEAD NC
28443-8731
US

IV. Provider business mailing address

2354 GADWALL LN
WINNABOW NC
28479-2500
US

V. Phone/Fax

Practice location:
  • Phone: 910-599-2230
  • Fax:
Mailing address:
  • Phone: 631-764-7794
  • 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: