Provider Demographics
NPI:1801500418
Name:KERR, ALYSSA DANIELLE (PA-C)
Entity type:Individual
Prefix:
First Name:ALYSSA
Middle Name:DANIELLE
Last Name:KERR
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:15 SARINA DR
Mailing Address - Street 2:
Mailing Address - City:COMMACK
Mailing Address - State:NY
Mailing Address - Zip Code:11725-1805
Mailing Address - Country:US
Mailing Address - Phone:631-807-8710
Mailing Address - Fax:
Practice Address - Street 1:353 VETERANS MEMORIAL HWY STE 101
Practice Address - Street 2:
Practice Address - City:COMMACK
Practice Address - State:NY
Practice Address - Zip Code:11725-4200
Practice Address - Country:US
Practice Address - Phone:631-543-4888
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-09
Last Update Date:2023-01-18
Deactivation Date:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant