Healthcare Provider Details

I. General information

NPI: 1720348402
Provider Name (Legal Business Name): ALYSE SHERWIN BLANCHETTE M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/29/2012
Last Update Date: 11/07/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

391 MYRTLE AVE STE 200
ALBANY NY
12208-3835
US

IV. Provider business mailing address

391 MYRTLE AVE STE 200
ALBANY NY
12208-3835
US

V. Phone/Fax

Practice location:
  • Phone: 518-262-4942
  • Fax: 518-262-5291
Mailing address:
  • Phone: 516-606-8699
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number278531-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: