Healthcare Provider Details

I. General information

NPI: 1659209765
Provider Name (Legal Business Name): ALYSSA N PEAKE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/11/2026
Last Update Date: 05/11/2026
Certification Date: 05/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

883 HANLEY RD APT B
NEWARK NY
14513-8926
US

IV. Provider business mailing address

883 HANLEY RD
NEWARK NY
14513-8926
US

V. Phone/Fax

Practice location:
  • Phone: 585-797-9755
  • Fax: 585-797-9755
Mailing address:
  • Phone: 585-797-9755
  • Fax: 585-797-9755

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number1324730
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: