MEDICARE: ALYSSA MAY CARILLO PANGANDOYON

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	044728	NY

General Provider Information

NPI Number	:	1538704689
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALYSSA MAY CARILLO PANGANDOYON

Provider Business Mailing Address
First Line	:	11920 UNION TPKE APT 3B1
Second Line	:
City	:	KEW GARDENS
State	:	NY
Zip	:	11415-1156
Country	:	US
Telephone Number	:	562-569-5731
Fax Number	:

Provider Business Practice Location Address
First Line	:	11920 UNION TPKE APT 3B1
Second Line	:
City	:	KEW GARDENS
State	:	NY
Zip	:	11415-1156
Country	:	US
Telephone Number	:	562-569-5731
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/13/2019
Last Update Date	:	11/13/2019

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Directions to “ ALYSSA MAY CARILLO PANGANDOYON ” Practice Location

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