Healthcare Provider Details

I. General information

NPI: 1679140057
Provider Name (Legal Business Name): ALYSSA ANN NAYLOR CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/05/2021
Last Update Date: 02/13/2023
Certification Date: 02/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5000 BRITTONFIELD PKWY STE A128
EAST SYRACUSE NY
13057-9228
US

IV. Provider business mailing address

5000 BRITTONFIELD PKWY STE A128
EAST SYRACUSE NY
13057-9228
US

V. Phone/Fax

Practice location:
  • Phone: 315-446-4400
  • Fax: 315-446-4201
Mailing address:
  • Phone: 315-446-4400
  • Fax: 315-446-4201

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number002081
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License NumberF421517
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: