Provider Demographics
NPI:1962107128
Name:MCCLELLAN, ALEXANDRA MARIE (NP)
Entity type:Individual
Prefix:
First Name:ALEXANDRA
Middle Name:MARIE
Last Name:MCCLELLAN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:228 PARK AVE S STE 15314
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10003-1502
Mailing Address - Country:US
Mailing Address - Phone:866-306-2026
Mailing Address - Fax:833-228-5591
Practice Address - Street 1:161 CECIL B MOORE AVE APT 204
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19122-3243
Practice Address - Country:US
Practice Address - Phone:215-585-2144
Practice Address - Fax:267-780-7032
Is Sole Proprietor?:No
Enumeration Date:2023-04-04
Last Update Date:2025-11-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PARN725016163W00000X
PASP027718363LP0808X
DEL8-0010697363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner