Healthcare Provider Details

I. General information

NPI: 1063316990
Provider Name (Legal Business Name): ALEXIS BLACK-HUDSON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: ALEXIS BLACK

II. Dates (important events)

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

III. Provider practice location address

608 OAK NECK RD
WEST ISLIP NY
11795-3617
US

IV. Provider business mailing address

608 OAK NECK RD
WEST ISLIP NY
11795-3617
US

V. Phone/Fax

Practice location:
  • Phone: 631-901-9503
  • Fax:
Mailing address:
  • Phone: 631-901-9503
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374J00000X
TaxonomyDoula
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: