Provider Demographics
NPI:1033919279
Name:EJIASI, ALISON (PMHNP-BC)
Entity type:Individual
Prefix:
First Name:ALISON
Middle Name:
Last Name:EJIASI
Suffix:
Gender:F
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:ALISON
Other - Middle Name:
Other - Last Name:SHAW
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1030 PRESIDENT AVE # 3002
Mailing Address - Street 2:
Mailing Address - City:FALL RIVER
Mailing Address - State:MA
Mailing Address - Zip Code:02720-5928
Mailing Address - Country:US
Mailing Address - Phone:508-679-6833
Mailing Address - Fax:
Practice Address - Street 1:1030 PRESIDENT AVE # 3002
Practice Address - Street 2:
Practice Address - City:FALL RIVER
Practice Address - State:MA
Practice Address - Zip Code:02720-5928
Practice Address - Country:US
Practice Address - Phone:508-679-6833
Practice Address - Fax:774-294-4056
Is Sole Proprietor?:No
Enumeration Date:2025-03-17
Last Update Date:2025-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2344535363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health