Healthcare Provider Details

I. General information

NPI: 1487626255
Provider Name (Legal Business Name): DEBORAH ALLIS PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/06/2006
Last Update Date: 07/15/2025
Certification Date: 07/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2235 CEDAR LN STE 302
VIENNA VA
22182-5247
US

IV. Provider business mailing address

400 E MAIN ST
MOUNT KISCO NY
10549-3417
US

V. Phone/Fax

Practice location:
  • Phone: 703-494-1020
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number000942
License Number StateCT
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number003861
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: