Provider Demographics
NPI:1922554518
Name:SEBASTIANELLI, ALYSSA (NP)
Entity Type:Individual
Prefix:
First Name:ALYSSA
Middle Name:
Last Name:SEBASTIANELLI
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1800 E PARK AVE
Mailing Address - Street 2:
Mailing Address - City:STATE COLLEGE
Mailing Address - State:PA
Mailing Address - Zip Code:16803-6701
Mailing Address - Country:US
Mailing Address - Phone:814-278-4631
Mailing Address - Fax:814-278-4685
Practice Address - Street 1:3901 S ATHERTON ST STE 2
Practice Address - Street 2:
Practice Address - City:STATE COLLEGE
Practice Address - State:PA
Practice Address - Zip Code:16801-8324
Practice Address - Country:US
Practice Address - Phone:814-278-4631
Practice Address - Fax:814-278-4685
Is Sole Proprietor?:No
Enumeration Date:2016-09-01
Last Update Date:2024-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP016454363LF0000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily