Provider Demographics
NPI:1922358803
Name:CSENDOM, ALYSSA L (TSSLD)
Entity Type:Individual
Prefix:
First Name:ALYSSA
Middle Name:L
Last Name:CSENDOM
Suffix:
Gender:F
Credentials:TSSLD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2399 ORANGEVILLE CENTER RD
Mailing Address - Street 2:
Mailing Address - City:VARYSBURG
Mailing Address - State:NY
Mailing Address - Zip Code:14167-9743
Mailing Address - Country:US
Mailing Address - Phone:585-535-0294
Mailing Address - Fax:
Practice Address - Street 1:2399 ORANGEVILLE CENTER RD
Practice Address - Street 2:
Practice Address - City:VARYSBURG
Practice Address - State:NY
Practice Address - Zip Code:14167-9743
Practice Address - Country:US
Practice Address - Phone:585-535-0294
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-09-18
Last Update Date:2012-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY592274121174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist