Individual
ALYSSA MICHELLE CHURCHILL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
376 E MAIN ST STE 101, BAY SHORE, NY 11706-8441
(631) 539-5400
Mailing address
376 E MAIN ST STE 101, BAY SHORE, NY 11706-8441
(631) 539-5400
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
309766
NY
2080P0202X
Pediatric Cardiology Physician
Primary
309766
NY
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
04/06/2018
Last updated
07/28/2025
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