Provider Demographics
NPI:1265321681
Name:TAYLOR, ALYSSIA TYRELL (DOD, NPI)
Entity type:Individual
Prefix:MS
First Name:ALYSSIA
Middle Name:TYRELL
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:DOD, NPI
Other - Prefix:DR
Other - First Name:ALYSSIA
Other - Middle Name:TYRELL
Other - Last Name:TAYLOR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DOR, DOD
Mailing Address - Street 1:P.O. BOX 3041
Mailing Address - Street 2:
Mailing Address - City:MARTINSVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:24115-3041
Mailing Address - Country:US
Mailing Address - Phone:540-505-9397
Mailing Address - Fax:
Practice Address - Street 1:P.O. BOX 3041
Practice Address - Street 2:
Practice Address - City:MARTINSVILLE
Practice Address - State:VA
Practice Address - Zip Code:24115-3041
Practice Address - Country:US
Practice Address - Phone:540-505-9397
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-07-01
Last Update Date:2025-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA10492248643171W00000X, 246Z00000X
ZZ0800204400321710I1002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Corpsman
No171W00000XOther Service ProvidersContractor
No246Z00000XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA089020440032Medicaid
NY203128076OtherINSURANCE INC