Healthcare Provider Details

I. General information

NPI: 1679230544
Provider Name (Legal Business Name): ALEXIS VALAIKA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/26/2021
Last Update Date: 09/29/2022
Certification Date: 09/18/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 OLD YORK ROAD SUITE 203
JENKINTOWN PA
19046
US

IV. Provider business mailing address

500 OLD YORK ROAD SUITE 203
JENKINTOWN PA
19046
US

V. Phone/Fax

Practice location:
  • Phone: 215-886-0174
  • Fax:
Mailing address:
  • Phone: 215-886-0174
  • Fax: 215-886-9217

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberSP023672
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: