Healthcare Provider Details

I. General information

NPI: 1083546006
Provider Name (Legal Business Name): ALYSSA MARIE DIXON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/02/2026
Last Update Date: 06/02/2026
Certification Date: 06/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3152 CAMBRIDGE SQ S APT D
BLASDELL NY
14219-1325
US

IV. Provider business mailing address

3152 CAMBRIDGE SQ S APT D
BLASDELL NY
14219-1325
US

V. Phone/Fax

Practice location:
  • Phone: 716-316-7758
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number031859
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number28984
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: