Provider Demographics
NPI:1235513763
Name:PICCILLO, ALYSSA MARIE (DPM)
Entity Type:Individual
Prefix:DR
First Name:ALYSSA
Middle Name:MARIE
Last Name:PICCILLO
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 40068
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19106-0068
Mailing Address - Country:US
Mailing Address - Phone:267-909-9594
Mailing Address - Fax:267-367-5559
Practice Address - Street 1:500 FAIRMOUNT AVE FL 1
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19123-2890
Practice Address - Country:US
Practice Address - Phone:267-909-9594
Practice Address - Fax:267-367-5559
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-14
Last Update Date:2022-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASC006672213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery