Healthcare Provider Details

I. General information

NPI: 1053220483
Provider Name (Legal Business Name): ALIGNED NUTRITION BY ALYSSA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/02/2026
Last Update Date: 09/02/2026
Certification Date: 09/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3738 SUSAN LN
BROOKHAVEN PA
19015-2223
US

IV. Provider business mailing address

3738 SUSAN LN
BROOKHAVEN PA
19015-2223
US

V. Phone/Fax

Practice location:
  • Phone: 856-296-3284
  • Fax:
Mailing address:
  • Phone:
  • 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 ANASTASIA
Title or Position: REGISTERED DIETITIAN NUTRITIONIST
Credential: RDN
Phone: 856-296-3284