Healthcare Provider Details

I. General information

NPI: 1861120677
Provider Name (Legal Business Name): ALYSSE CUPELLI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/10/2022
Last Update Date: 08/10/2022
Certification Date: 08/10/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

322 W WILLIAM CANNON DR
AUSTIN TX
78745-5691
US

IV. Provider business mailing address

322 W WILLIAM CANNON DR
AUSTIN TX
78745-5691
US

V. Phone/Fax

Practice location:
  • Phone: 512-601-6587
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: