Healthcare Provider Details

I. General information

NPI: 1962107128
Provider Name (Legal Business Name): ALEXANDRA MARIE MCCLELLAN NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/04/2023
Last Update Date: 11/06/2025
Certification Date: 11/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

161 CECIL B MOORE AVE APT 204
PHILADELPHIA PA
19122-3243
US

IV. Provider business mailing address

228 PARK AVE S STE 15314
NEW YORK NY
10003-1502
US

V. Phone/Fax

Practice location:
  • Phone: 215-585-2144
  • Fax: 267-780-7032
Mailing address:
  • Phone: 866-306-2026
  • Fax: 833-228-5591

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN725016
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberSP027718
License Number StatePA
# 3
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberL8-0010697
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: