Healthcare Provider Details

I. General information

NPI: 1811504335
Provider Name (Legal Business Name): JACLYN MCCABE RD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JACLYN CORRADO

II. Dates (important events)

Enumeration Date: 09/29/2020
Last Update Date: 06/24/2025
Certification Date: 06/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1520 SUNDAY DR STE 309
RALEIGH NC
27607-5254
US

IV. Provider business mailing address

1520 SUNDAY DR STE 309
RALEIGH NC
27607-5254
US

V. Phone/Fax

Practice location:
  • Phone: 919-354-7077
  • Fax: 919-354-7075
Mailing address:
  • Phone: 919-354-7077
  • Fax: 919-354-7075

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133N00000X
TaxonomyNutritionist
License NumberL006066
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code133NN1002X
TaxonomyNutrition Education Nutritionist
License NumberL006066
License Number StateNC
# 3
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberL006066
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: