Provider Demographics
NPI:1801249768
Name:SEDGHIKHOI-MILANI, ALYSSA MORGAN
Entity type:Individual
Prefix:
First Name:ALYSSA
Middle Name:MORGAN
Last Name:SEDGHIKHOI-MILANI
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 1:6196 LAKE GRAY BLVD STE 117
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32244-5867
Mailing Address - Country:US
Mailing Address - Phone:904-456-1204
Mailing Address - Fax:
Practice Address - Street 1:6196 LAKE GRAY BLVD STE 117
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32244-5867
Practice Address - Country:US
Practice Address - Phone:904-456-1204
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-07-15
Last Update Date:2024-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL0189135103K00000X, 103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst