Individual
MS. ALLISON D LY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
3319 S STATE ROAD 7 STE 102, WELLINGTON, FL 33449-8099
(561) 333-4000
(561) 333-8851
Mailing address
367 S. GULPH RD, ATTN: IPM CREDENTIALING, KING OF PRUSSIA, PA 19406-3121
(561) 333-4000
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA9100938
FL
363AM0700X
Medical Physician Assistant
PA9100938
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
291006300
—
FL
Enumeration date
05/28/2006
Last updated
07/08/2019
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