Healthcare Provider Details

I. General information

NPI: 1750206165
Provider Name (Legal Business Name): ALYSSA PACHECO NUTRITION LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/13/2026
Last Update Date: 08/13/2026
Certification Date: 08/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8 RIVERS EDGE WAY
ASSONET MA
02702-1127
US

IV. Provider business mailing address

8 RIVERS EDGE WAY
ASSONET MA
02702-1127
US

V. Phone/Fax

Practice location:
  • Phone: 401-529-7042
  • Fax:
Mailing address:
  • Phone: 401-529-7042
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number
License Number State

VIII. Authorized Official

Name: ALYSSA PACHECO
Title or Position: REGISTERED DIETITIAN
Credential: RD
Phone: 401-529-7042