MEDICARE: MS. ALYSSA DANIELLE ALLEM MD

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	207Q00000X	Family Medicine Physician	ME164371	FL

General Provider Information

NPI Number	:	1881263713
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. ALYSSA DANIELLE ALLEM MD

Provider Business Mailing Address
First Line	:	1651 SE TIFFANY AVE
Second Line	:
City	:	PORT SAINT LUCIE
State	:	FL
Zip	:	34952-7564
Country	:	US
Telephone Number	:	772-398-1800
Fax Number	:	772-398-1825

Provider Business Practice Location Address
First Line	:	1651 SE TIFFANY AVE
Second Line	:
City	:	PORT SAINT LUCIE
State	:	FL
Zip	:	34952-7564
Country	:	US
Telephone Number	:	772-398-1800
Fax Number	:

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

Provider Enumeration Date	:	06/24/2021
Last Update Date	:	08/23/2024

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