Healthcare Provider Details

I. General information

NPI: 1912811621
Provider Name (Legal Business Name): ALYSSA LEE GALLI
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/30/2026
Last Update Date: 09/30/2026
Certification Date: 09/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1280 E STRINGHAM AVE
SALT LAKE CITY UT
84106-2490
US

IV. Provider business mailing address

1774 S 1600 W
WOODS CROSS UT
84087-2287
US

V. Phone/Fax

Practice location:
  • Phone: 801-213-9797
  • Fax: 801-213-8360
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number11741948-3102
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: