1225647951 NPI number — SPECTRUM WARRIORS, INC.

Table of content: ALYSSA JULIA MELO DO (NPI 1245817824)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1225647951 NPI number — SPECTRUM WARRIORS, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SPECTRUM WARRIORS, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1225647951
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/28/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
200 W 143RD ST APT 18E
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NEW YORK
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10030-1530
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
917-539-2026
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
263 RILEY RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NEW WINDSOR
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
12553-7272
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
917-539-2026
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/28/2020

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
SANCHEZ-STIERHEIM
Authorized Official First Name:
MICHELE
Authorized Official Middle Name:
Authorized Official Title or Position:
FOUNDER
Authorized Official Telephone Number:
917-539-2026

Provider Taxonomy Codes

  • Taxonomy code: 385HR2050X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 385HR2060X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 385H00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: AC152425 . This is a "ADVANCED AUTISM CERTIFICATE, DIR FLOORTIME PROVIDER, CRISIS MANAGEMENT" identifier . This identifiers is of the category "OTHER".