Provider Demographics
NPI:1093314247
Name:GEORGIO, ALLISA GLADYS (MS, RD)
Entity Type:Individual
Prefix:MS
First Name:ALLISA
Middle Name:GLADYS
Last Name:GEORGIO
Suffix:
Gender:F
Credentials:MS, RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:71 OLD PINE RD
Mailing Address - Street 2:
Mailing Address - City:NARRAGANSETT
Mailing Address - State:RI
Mailing Address - Zip Code:02882-2406
Mailing Address - Country:US
Mailing Address - Phone:401-338-8704
Mailing Address - Fax:
Practice Address - Street 1:71 OLD PINE RD
Practice Address - Street 2:
Practice Address - City:NARRAGANSETT
Practice Address - State:RI
Practice Address - Zip Code:02882-2406
Practice Address - Country:US
Practice Address - Phone:401-338-8704
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-20
Last Update Date:2020-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered