Provider Demographics
NPI:1922744382
Name:MASSEY, ALYSSA (MS,RD,LD)
Entity Type:Individual
Prefix:
First Name:ALYSSA
Middle Name:
Last Name:MASSEY
Suffix:
Gender:F
Credentials:MS,RD,LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5359 FREDERICKSBURG RD APT 401
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78229-3545
Mailing Address - Country:US
Mailing Address - Phone:956-466-0882
Mailing Address - Fax:
Practice Address - Street 1:5359 FREDERICKSBURG RD APT 401
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229-3545
Practice Address - Country:US
Practice Address - Phone:956-466-0882
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-09
Last Update Date:2022-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDT86812133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered