Provider Demographics
NPI:1033466099
Name:PARADISE, ALEXANDRA NICOLE (MS ED)
Entity Type:Individual
Prefix:MS
First Name:ALEXANDRA
Middle Name:NICOLE
Last Name:PARADISE
Suffix:
Gender:F
Credentials:MS ED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27 CRANBERRY CT
Mailing Address - Street 2:
Mailing Address - City:MARLTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08053-3770
Mailing Address - Country:US
Mailing Address - Phone:856-904-9984
Mailing Address - Fax:
Practice Address - Street 1:27 CRANBERRY CT
Practice Address - Street 2:
Practice Address - City:MARLTON
Practice Address - State:NJ
Practice Address - Zip Code:08053-3770
Practice Address - Country:US
Practice Address - Phone:856-904-9984
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-09
Last Update Date:2012-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist