Healthcare Provider Details

I. General information

NPI: 1184865446
Provider Name (Legal Business Name): ELLEN M DALEY RD, LDN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/17/2009
Last Update Date: 03/17/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2610 NEW BERN AVE
RALEIGH NC
27610-1821
US

IV. Provider business mailing address

3000 NEW BERN AVE
RALEIGH NC
27610-1231
US

V. Phone/Fax

Practice location:
  • Phone: 919-350-7404
  • Fax:
Mailing address:
  • Phone: 919-350-7404
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133N00000X
TaxonomyNutritionist
License NumberL001304
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number727618
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: