Provider Demographics
NPI:1497555601
Name:SIDWELL, ALYSSA MAUREEN
Entity type:Individual
Prefix:
First Name:ALYSSA
Middle Name:MAUREEN
Last Name:SIDWELL
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 1:12568 MELODY LN
Mailing Address - Street 2:
Mailing Address - City:GRAFTON
Mailing Address - State:OH
Mailing Address - Zip Code:44044-9507
Mailing Address - Country:US
Mailing Address - Phone:440-541-8118
Mailing Address - Fax:
Practice Address - Street 1:12568 MELODY LN
Practice Address - Street 2:
Practice Address - City:GRAFTON
Practice Address - State:OH
Practice Address - Zip Code:44044-9507
Practice Address - Country:US
Practice Address - Phone:440-541-8118
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-17
Last Update Date:2025-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide