Healthcare Provider Details

I. General information

NPI: 1255209540
Provider Name (Legal Business Name): BREAK THE CYCLE NUTRITION, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/28/2025
Last Update Date: 10/28/2025
Certification Date: 10/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1709 SONESTA CT
RALEIGH NC
27613-8562
US

IV. Provider business mailing address

1709 SONESTA CT
RALEIGH NC
27613-8562
US

V. Phone/Fax

Practice location:
  • Phone: 919-622-2174
  • Fax:
Mailing address:
  • Phone: 919-622-2174
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133NN1002X
TaxonomyNutrition Education Nutritionist
License Number
License Number State

VIII. Authorized Official

Name: PATRICIA DIANE BUTLER
Title or Position: OWNER
Credential: RD, LDN, CDCES
Phone: 919-622-2174