Provider Demographics
NPI:1205225489
Name:ALLEY, CRYSTAL (MSED)
Entity Type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:
Last Name:ALLEY
Suffix:
Gender:F
Credentials:MSED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:801 S HUTH RD
Mailing Address - Street 2:
Mailing Address - City:CHEEKTOWAGA
Mailing Address - State:NY
Mailing Address - Zip Code:14225-1722
Mailing Address - Country:US
Mailing Address - Phone:315-657-5706
Mailing Address - Fax:
Practice Address - Street 1:790 RIDGE RD
Practice Address - Street 2:
Practice Address - City:LACKAWANNA
Practice Address - State:NY
Practice Address - Zip Code:14218-1629
Practice Address - Country:US
Practice Address - Phone:716-822-4781
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-01-12
Last Update Date:2015-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist