Provider Demographics
NPI:1649743907
Name:ACQUAVIVA, ALYSSA N (PA-C)
Entity Type:Individual
Prefix:
First Name:ALYSSA
Middle Name:N
Last Name:ACQUAVIVA
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:ALYSSA
Other - Middle Name:
Other - Last Name:MEHLHORN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1307 FEDERAL ST STE 2
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15212-4769
Mailing Address - Country:US
Mailing Address - Phone:877-660-6777
Mailing Address - Fax:412-359-8055
Practice Address - Street 1:1307 FEDERAL ST STE 2
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15212-4769
Practice Address - Country:US
Practice Address - Phone:877-660-6777
Practice Address - Fax:412-359-8055
Is Sole Proprietor?:No
Enumeration Date:2019-01-09
Last Update Date:2023-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA060350363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant