Provider Demographics
NPI:1689471401
Name:SY, ALYSSA (MT-BC)
Entity type:Individual
Prefix:
First Name:ALYSSA
Middle Name:
Last Name:SY
Suffix:
Gender:
Credentials:MT-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12921 RIVER RD
Mailing Address - Street 2:
Mailing Address - City:POTOMAC
Mailing Address - State:MD
Mailing Address - Zip Code:20854-1141
Mailing Address - Country:US
Mailing Address - Phone:336-404-1703
Mailing Address - Fax:
Practice Address - Street 1:12921 RIVER RD
Practice Address - Street 2:
Practice Address - City:POTOMAC
Practice Address - State:MD
Practice Address - Zip Code:20854-1141
Practice Address - Country:US
Practice Address - Phone:336-404-1703
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-27
Last Update Date:2025-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD00189225A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225A00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMusic Therapist