Healthcare Provider Details

I. General information

NPI: 1093314247
Provider Name (Legal Business Name): ALLISA GLADYS PELLEGRINO MS, RD, LDN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/20/2020
Last Update Date: 02/27/2025
Certification Date: 02/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6013 FARRINGTON RD STE 201
CHAPEL HILL NC
27517-8173
US

IV. Provider business mailing address

22 WINDCHIME CT
FUQUAY VARINA NC
27526-4365
US

V. Phone/Fax

Practice location:
  • Phone: 401-338-8704
  • Fax:
Mailing address:
  • Phone: 401-338-8704
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code133VN1004X
TaxonomyPediatric Nutrition Registered Dietitian
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: