Healthcare Provider Details

I. General information

NPI: 1598535791
Provider Name (Legal Business Name): AYLEENA LYLES
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/08/2024
Last Update Date: 10/03/2026
Certification Date: 10/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

89 LAKEWIND CT
SANFORD NC
27332-0612
US

IV. Provider business mailing address

1111 BOONE HALL WAY APT 201
FAYETTEVILLE NC
28303-6034
US

V. Phone/Fax

Practice location:
  • Phone: 919-601-4785
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-26-2854865
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: