Active NPI
Aleisa Myles, PSYD
- Psychologist
- Philadelphia, PA
National Provider Identifier
1104426618
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychologist
- License
- PS018467
- Practice address
- 2200 Saint James PL
Philadelphia, PA 19103-5860 - Phone
- (610) 257-7065
- NPI assigned
- Oct 26, 2020
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychologist | 103T00000X | PS018467 | PA | Primary |
Addresses
Primary practice location
2200 Saint James PL
Philadelphia, PA 19103-5860
Mailing address
2200 Saint James PL
Philadelphia, PA 19103-5860
Phone (610) 257-7065
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective Jul 1, 2018 through Jul 1, 2028
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PS018467 | PA | MD | Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1603670400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1603670400000",
"number": "1104426618",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2200 SAINT JAMES PL",
"city": "PHILADELPHIA",
"state": "PA",
"postal_code": "191035860",
"telephone_number": "610-257-7065"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2200 SAINT JAMES PL",
"city": "PHILADELPHIA",
"state": "PA",
"postal_code": "191035860",
"telephone_number": "610-257-7065"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MYLES",
"first_name": "ALEISA",
"credential": "PSYD",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2020-10-26",
"last_updated": "2020-10-26",
"certification_date": "2020-10-26",
"status": "A"
},
"taxonomies": [
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "PA",
"license": "PS018467",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Philadelphia, PA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 26, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.