Healthcare Provider Details

I. General information

NPI: 1144167149
Provider Name (Legal Business Name): ALYSSA MARIE DORIA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/29/2026
Last Update Date: 04/29/2026
Certification Date: 04/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1413 STONY BROOK RD
STONY BROOK NY
11790-2214
US

IV. Provider business mailing address

20 SKYVIEW PL
MELVILLE NY
11747-1530
US

V. Phone/Fax

Practice location:
  • Phone: 631-444-0101
  • Fax:
Mailing address:
  • Phone: 631-525-6836
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: