Provider Demographics
NPI:1770946790
Name:SCHUNK, ALYSSA (DO)
Entity type:Individual
Prefix:
First Name:ALYSSA
Middle Name:
Last Name:SCHUNK
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2001 W MAIN ST STE 132
Mailing Address - Street 2:
Mailing Address - City:STAMFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06902-4544
Mailing Address - Country:US
Mailing Address - Phone:203-363-0123
Mailing Address - Fax:475-619-9855
Practice Address - Street 1:2001 W MAIN ST
Practice Address - Street 2:
Practice Address - City:STAMFORD
Practice Address - State:CT
Practice Address - Zip Code:06902-4501
Practice Address - Country:US
Practice Address - Phone:203-363-1023
Practice Address - Fax:475-619-9855
Is Sole Proprietor?:No
Enumeration Date:2016-03-29
Last Update Date:2024-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY298113208000000X
390200000X
CT69377208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program