Provider Demographics
NPI:1821609355
Name:RODANICHE, ALYSSA (PA)
Entity type:Individual
Prefix:
First Name:ALYSSA
Middle Name:
Last Name:RODANICHE
Suffix:
Gender:F
Credentials:PA
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Mailing Address - Street 1:8300 N LAMAR BLVD STE 200A
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78753-5976
Mailing Address - Country:US
Mailing Address - Phone:512-575-9555
Mailing Address - Fax:512-782-9316
Practice Address - Street 1:11521 N FM 620 RD STE 945
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78726-1115
Practice Address - Country:US
Practice Address - Phone:512-318-2559
Practice Address - Fax:512-782-9316
Is Sole Proprietor?:No
Enumeration Date:2020-08-10
Last Update Date:2024-11-05
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TXPA16170363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant