Provider Demographics
NPI:1629706551
Name:CONSTANTINO, ALYSSA BROOKE (PA)
Entity type:Individual
Prefix:
First Name:ALYSSA
Middle Name:BROOKE
Last Name:CONSTANTINO
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:180 CHURCH HILL RD STE 1
Mailing Address - Street 2:
Mailing Address - City:LEEDS
Mailing Address - State:ME
Mailing Address - Zip Code:04263-3418
Mailing Address - Country:US
Mailing Address - Phone:207-524-3501
Mailing Address - Fax:207-524-2093
Practice Address - Street 1:7 MAIN ST
Practice Address - Street 2:
Practice Address - City:TURNER
Practice Address - State:ME
Practice Address - Zip Code:04282-4138
Practice Address - Country:US
Practice Address - Phone:207-524-3501
Practice Address - Fax:207-225-2692
Is Sole Proprietor?:No
Enumeration Date:2022-08-09
Last Update Date:2025-08-05
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MAPA8912363AM0700X
WAPA61646555363AM0700X
MEPA2908363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical