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Individual

ALYSSA ROSE JACULLO

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F

Contact information

Practice address
1 PRESIDENTIAL BLVD, BALA CYNWYD, PA 19004-1017
(215) 264-2574
Mailing address
12430 WYNDOM RD, PHILADELPHIA, PA 19154-1322
(631) 943-1616

Taxonomy

Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
DN007895
PA

Other

Enumeration date
11/07/2024
Last updated
11/07/2024
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