Provider Demographics
NPI:1104617992
Name:FALLON, ALYSSA ISABEL
Entity type:Individual
Prefix:
First Name:ALYSSA
Middle Name:ISABEL
Last Name:FALLON
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 1:826 E 1080 N
Mailing Address - Street 2:
Mailing Address - City:LEHI
Mailing Address - State:UT
Mailing Address - Zip Code:84043-1356
Mailing Address - Country:US
Mailing Address - Phone:760-585-8659
Mailing Address - Fax:
Practice Address - Street 1:248 E 13800 S STE 3
Practice Address - Street 2:
Practice Address - City:DRAPER
Practice Address - State:UT
Practice Address - Zip Code:84020-5011
Practice Address - Country:US
Practice Address - Phone:801-987-8384
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-13
Last Update Date:2025-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program