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General NPI Number Information
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NPI Number | 1083451520
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Entity Type | Individual
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Provider Name | ALLYSON FAHEY
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Gender | Female
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Dates
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Enumeration Date | 07/11/2024
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Last Update Date | 08/26/2024
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Provider Practice Location Address
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Address Line | 2816 W VIRGINIA AVE
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City | TAMPA
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State | FL
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Zip | 33607-6330
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Country | US
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Telephone | 813-876-6321
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Fax |
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Provider Business Mailing Address
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Address Line | 2816 W VIRGINIA AVE
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City | TAMPA
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State | FL
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Zip | 33607-6330
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number |
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License Number State | FL
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