Provider Demographics
NPI:1447981410
Name:TALLAS, ANALYSSA RYLIE (MS, CGC)
Entity type:Individual
Prefix:
First Name:ANALYSSA
Middle Name:RYLIE
Last Name:TALLAS
Suffix:
Gender:F
Credentials:MS, CGC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3360 KAMAAINA PL
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96817-1033
Mailing Address - Country:US
Mailing Address - Phone:512-848-9555
Mailing Address - Fax:
Practice Address - Street 1:1319 PUNAHOU ST STE 540
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96826-1046
Practice Address - Country:US
Practice Address - Phone:512-848-9555
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-21
Last Update Date:2022-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC19784170300000X
170300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes170300000XOther Service ProvidersGenetic Counselor, MS