Individual
ALYSSA G BOVALINO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
101 DATES DR, ITHACA, NY 14850-1342
(315) 480-8733
Mailing address
101 DATES DR, ITHACA, NY 14850-1342
(315) 698-1496
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
020196
NY
Other
Enumeration date
10/03/2016
Last updated
11/04/2016
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