Healthcare Provider Details

I. General information

NPI: 1568375152
Provider Name (Legal Business Name): AALYSA A VANNUCCI BHS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/24/2026
Last Update Date: 09/24/2026
Certification Date: 09/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16 S CENTER ST
CORRY PA
16407-1921
US

IV. Provider business mailing address

13695 W WASHINGTON STREET EXT LOT 30
CORRY PA
16407-9657
US

V. Phone/Fax

Practice location:
  • Phone: 814-581-2544
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: