Healthcare Provider Details

I. General information

NPI: 1083435465
Provider Name (Legal Business Name): ALYSSA TAYLOR
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/18/2024
Last Update Date: 09/04/2025
Certification Date: 09/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

165 E PARK AVE
NILES OH
44446-2352
US

IV. Provider business mailing address

3128 DENVER DR
POLAND OH
44514-2437
US

V. Phone/Fax

Practice location:
  • Phone: 330-544-8005
  • Fax:
Mailing address:
  • Phone: 330-219-6050
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0807X
TaxonomyChild & Adolescent Psychiatric/Mental Health Registered Nurse
License NumberRN.441045
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: