Provider Demographics
NPI:1043603806
Name:PAROS, ALYSSA MARIE (MS, RD, LDN)
Entity Type:Individual
Prefix:MRS
First Name:ALYSSA
Middle Name:MARIE
Last Name:PAROS
Suffix:
Gender:F
Credentials:MS, RD, LDN
Other - Prefix:MISS
Other - First Name:ALYSSA
Other - Middle Name:MARIE
Other - Last Name:KELLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, RD, LDN
Mailing Address - Street 1:127 LUNA LN
Mailing Address - Street 2:
Mailing Address - City:JOHNSTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:15904-3070
Mailing Address - Country:US
Mailing Address - Phone:814-254-7418
Mailing Address - Fax:
Practice Address - Street 1:127 LUNA LN
Practice Address - Street 2:
Practice Address - City:JOHNSTOWN
Practice Address - State:PA
Practice Address - Zip Code:15904-3070
Practice Address - Country:US
Practice Address - Phone:814-254-7418
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-17
Last Update Date:2015-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADN005251133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered