Provider Demographics
NPI:1275753709
Name:RILEY, ALEXIS L (AUD)
Entity Type:Individual
Prefix:DR
First Name:ALEXIS
Middle Name:L
Last Name:RILEY
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1325 36TH ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:VERO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32960-6599
Mailing Address - Country:US
Mailing Address - Phone:772-563-0015
Mailing Address - Fax:772-770-0799
Practice Address - Street 1:1325 36TH ST
Practice Address - Street 2:SUITE A
Practice Address - City:VERO BEACH
Practice Address - State:FL
Practice Address - Zip Code:32960-6599
Practice Address - Country:US
Practice Address - Phone:772-563-0015
Practice Address - Fax:772-770-0799
Is Sole Proprietor?:No
Enumeration Date:2007-04-26
Last Update Date:2011-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAZ516231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL600546200Medicaid
FL600546200Medicaid
FLAG998YMedicare PIN