Healthcare Provider Details

I. General information

NPI: 1407096324
Provider Name (Legal Business Name): MEGAN JAYCOX RDLD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/05/2009
Last Update Date: 10/08/2021
Certification Date: 10/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

507 DEL PRADO BLVD S
CAPE CORAL FL
33990-2618
US

IV. Provider business mailing address

PO BOX 2147
FORT MYERS FL
33902-2147
US

V. Phone/Fax

Practice location:
  • Phone: 239-424-3124
  • Fax: 239-424-1423
Mailing address:
  • Phone: 239-424-3124
  • Fax: 239-424-1423

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133VN1004X
TaxonomyPediatric Nutrition Registered Dietitian
License Number4424
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberND9150
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: