Provider Demographics
NPI:1053820795
Name:PIKE, ALYSSA CHRISTINE (RD)
Entity Type:Individual
Prefix:
First Name:ALYSSA
Middle Name:CHRISTINE
Last Name:PIKE
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13805 JEFFERSON PARK DR APT 2404
Mailing Address - Street 2:
Mailing Address - City:HERNDON
Mailing Address - State:VA
Mailing Address - Zip Code:20171-4780
Mailing Address - Country:US
Mailing Address - Phone:412-526-7261
Mailing Address - Fax:
Practice Address - Street 1:13805 JEFFERSON PARK DR APT 2404
Practice Address - Street 2:
Practice Address - City:HERNDON
Practice Address - State:VA
Practice Address - Zip Code:20171-4780
Practice Address - Country:US
Practice Address - Phone:412-526-7261
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-26
Last Update Date:2019-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
86067741133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
86067741OtherREGISTERED DIETITIAN