Provider Demographics
NPI:1245089374
Name:POWELL, ALEXYSS P
Entity type:Individual
Prefix:
First Name:ALEXYSS
Middle Name:P
Last Name:POWELL
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 1:21 SUNTREE PL STE 100
Mailing Address - Street 2:
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32940-7600
Mailing Address - Country:US
Mailing Address - Phone:321-254-5300
Mailing Address - Fax:321-254-5301
Practice Address - Street 1:21 SUNTREE PL STE 100
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32940-7600
Practice Address - Country:US
Practice Address - Phone:321-254-5300
Practice Address - Fax:321-254-5301
Is Sole Proprietor?:No
Enumeration Date:2024-05-13
Last Update Date:2024-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAY2862231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist