Provider Demographics
NPI:1619864394
Name:KIYAS, ACELINA
Entity type:Individual
Prefix:
First Name:ACELINA
Middle Name:
Last Name:KIYAS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:624 LANCASTER PIKE
Mailing Address - Street 2:
Mailing Address - City:NEW PROVIDENCE
Mailing Address - State:PA
Mailing Address - Zip Code:17560-9756
Mailing Address - Country:US
Mailing Address - Phone:732-675-8045
Mailing Address - Fax:
Practice Address - Street 1:624 LANCASTER PIKE
Practice Address - Street 2:
Practice Address - City:NEW PROVIDENCE
Practice Address - State:PA
Practice Address - Zip Code:17560-9756
Practice Address - Country:US
Practice Address - Phone:732-675-8045
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-23
Last Update Date:2025-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ133N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist