Provider Demographics
NPI:1275252579
Name:DIMELLA, ALLYSON JOANN
Entity type:Individual
Prefix:
First Name:ALLYSON
Middle Name:JOANN
Last Name:DIMELLA
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 1:2354 GADWALL LN
Mailing Address - Street 2:
Mailing Address - City:WINNABOW
Mailing Address - State:NC
Mailing Address - Zip Code:28479-2500
Mailing Address - Country:US
Mailing Address - Phone:631-764-7794
Mailing Address - Fax:
Practice Address - Street 1:239 RADIO AVE
Practice Address - Street 2:
Practice Address - City:MILLER PLACE
Practice Address - State:NY
Practice Address - Zip Code:11764-3528
Practice Address - Country:US
Practice Address - Phone:631-764-7794
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-22
Last Update Date:2025-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician