Provider Demographics
NPI:1285229518
Name:BALDASSANO, ALEXA LEIGH (AGNP-BC)
Entity Type:Individual
Prefix:MS
First Name:ALEXA
Middle Name:LEIGH
Last Name:BALDASSANO
Suffix:
Gender:F
Credentials:AGNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:534 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10310-2825
Mailing Address - Country:US
Mailing Address - Phone:999-999-9999
Mailing Address - Fax:
Practice Address - Street 1:534 BROADWAY
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10310-2825
Practice Address - Country:US
Practice Address - Phone:917-957-5040
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-08
Last Update Date:2021-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF-309757-01363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health