Provider Demographics
NPI:1578929535
Name:PRINCIPE, ALYSSA (RD, LDN)
Entity Type:Individual
Prefix:
First Name:ALYSSA
Middle Name:
Last Name:PRINCIPE
Suffix:
Gender:F
Credentials:RD, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:38 VANDERBILT AVE
Mailing Address - Street 2:STE E
Mailing Address - City:NORWOOD
Mailing Address - State:MA
Mailing Address - Zip Code:02062-5006
Mailing Address - Country:US
Mailing Address - Phone:781-269-5400
Mailing Address - Fax:781-269-5887
Practice Address - Street 1:38 VANDERBILT AVE
Practice Address - Street 2:
Practice Address - City:NORWOOD
Practice Address - State:MA
Practice Address - Zip Code:02062-5006
Practice Address - Country:US
Practice Address - Phone:781-269-5400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-01-06
Last Update Date:2016-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA00004021133N00000X
NY86069985133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist
No133V00000XDietary & Nutritional Service ProvidersDietitian, Registered