Provider Demographics
NPI:1073174371
Name:SHOCK, ALYSSA ANN (DOCTORAL STUDENT)
Entity Type:Individual
Prefix:MISS
First Name:ALYSSA
Middle Name:ANN
Last Name:SHOCK
Suffix:
Gender:F
Credentials:DOCTORAL STUDENT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:156 BROOK ST
Mailing Address - Street 2:
Mailing Address - City:DUMONT
Mailing Address - State:NJ
Mailing Address - Zip Code:07628-2425
Mailing Address - Country:US
Mailing Address - Phone:201-527-0902
Mailing Address - Fax:
Practice Address - Street 1:1695 MAIN ST
Practice Address - Street 2:SUITE 400
Practice Address - City:SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01103-1063
Practice Address - Country:US
Practice Address - Phone:413-739-5572
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-26
Last Update Date:2019-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program