Provider Demographics
NPI:1144742958
Name:HALYARD, ALEXIS SIENNA
Entity type:Individual
Prefix:
First Name:ALEXIS
Middle Name:SIENNA
Last Name:HALYARD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8640 SUDLEY RD STE 203
Mailing Address - Street 2:
Mailing Address - City:MANASSAS
Mailing Address - State:VA
Mailing Address - Zip Code:20110-4404
Mailing Address - Country:US
Mailing Address - Phone:571-662-5885
Mailing Address - Fax:703-368-2498
Practice Address - Street 1:8640 SUDLEY RD STE 203
Practice Address - Street 2:
Practice Address - City:MANASSAS
Practice Address - State:VA
Practice Address - Zip Code:20110-4404
Practice Address - Country:US
Practice Address - Phone:571-662-5885
Practice Address - Fax:703-368-2498
Is Sole Proprietor?:No
Enumeration Date:2017-07-13
Last Update Date:2024-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2022-03066207Q00000X
VA0101279272207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine