Provider Demographics
NPI:1366212227
Name:HADDAD, HOLLY ALYSSA (RD)
Entity type:Individual
Prefix:
First Name:HOLLY
Middle Name:ALYSSA
Last Name:HADDAD
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:39482 SPRINGWATER DR
Mailing Address - Street 2:
Mailing Address - City:NORTHVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48168-3959
Mailing Address - Country:US
Mailing Address - Phone:734-377-0856
Mailing Address - Fax:
Practice Address - Street 1:1934 LIVERNOIS RD
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:MI
Practice Address - Zip Code:48083-1732
Practice Address - Country:US
Practice Address - Phone:248-686-0340
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-03
Last Update Date:2024-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI86326274133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered