Provider Demographics
NPI:1871906115
Name:DALLICARDILLO, ALYSSA (APN-C)
Entity type:Individual
Prefix:
First Name:ALYSSA
Middle Name:
Last Name:DALLICARDILLO
Suffix:
Gender:F
Credentials:APN-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:305 PRINCETON AVE
Mailing Address - Street 2:
Mailing Address - City:BAYVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08721-2313
Mailing Address - Country:US
Mailing Address - Phone:732-779-9235
Mailing Address - Fax:
Practice Address - Street 1:175 GUNNING RIVER RD BLDG E
Practice Address - Street 2:
Practice Address - City:BARNEGAT
Practice Address - State:NJ
Practice Address - Zip Code:08005-1436
Practice Address - Country:US
Practice Address - Phone:609-926-8899
Practice Address - Fax:609-660-8052
Is Sole Proprietor?:No
Enumeration Date:2014-06-04
Last Update Date:2023-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00501400363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health