Provider Demographics
NPI:1396584546
Name:HAKIM, ALYSSA DARRYLIS I
Entity type:Individual
Prefix:
First Name:ALYSSA
Middle Name:DARRYLIS
Last Name:HAKIM
Suffix:I
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 1:128 RHOBELLA DR # B
Mailing Address - Street 2:
Mailing Address - City:POUGHKEEPSIE
Mailing Address - State:NY
Mailing Address - Zip Code:12603-1932
Mailing Address - Country:US
Mailing Address - Phone:845-453-1050
Mailing Address - Fax:
Practice Address - Street 1:128 RHOBELLA DR # B
Practice Address - Street 2:
Practice Address - City:POUGHKEEPSIE
Practice Address - State:NY
Practice Address - Zip Code:12603-1932
Practice Address - Country:US
Practice Address - Phone:845-453-1050
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-20
Last Update Date:2024-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY325833164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse