Provider Demographics
NPI:1578855128
Name:BACARELLA, ALYSONDRA ROBINSON
Entity Type:Individual
Prefix:MRS
First Name:ALYSONDRA
Middle Name:ROBINSON
Last Name:BACARELLA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 PATRICIA COURT
Mailing Address - Street 2:
Mailing Address - City:MIDDLE ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:11953
Mailing Address - Country:US
Mailing Address - Phone:631-413-4259
Mailing Address - Fax:
Practice Address - Street 1:11 PATRICIA CT
Practice Address - Street 2:
Practice Address - City:MIDDLE ISLAND
Practice Address - State:NY
Practice Address - Zip Code:11953-1417
Practice Address - Country:US
Practice Address - Phone:631-413-4259
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-13
Last Update Date:2022-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY301948-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse