Provider Demographics
NPI:1447627484
Name:REIDHEAD, ALYSSA SHAELYN (RD)
Entity type:Individual
Prefix:
First Name:ALYSSA
Middle Name:SHAELYN
Last Name:REIDHEAD
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:ALYSSA
Other - Middle Name:SHAELYN
Other - Last Name:O'TOOLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD
Mailing Address - Street 1:128 S 1350 E
Mailing Address - Street 2:
Mailing Address - City:HYRUM
Mailing Address - State:UT
Mailing Address - Zip Code:84319-2029
Mailing Address - Country:US
Mailing Address - Phone:702-423-7657
Mailing Address - Fax:
Practice Address - Street 1:128 S 1350 E
Practice Address - Street 2:
Practice Address - City:HYRUM
Practice Address - State:UT
Practice Address - Zip Code:84319-2029
Practice Address - Country:US
Practice Address - Phone:702-423-7657
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-25
Last Update Date:2022-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT9539729-4901133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered