Healthcare Provider Details

I. General information

NPI: 1275429466
Provider Name (Legal Business Name): STEPHANIE HASSELL RDN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/16/2025
Last Update Date: 09/08/2026
Certification Date: 09/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

205 W MILLBROOK RD STE 205
RALEIGH NC
27609-4492
US

IV. Provider business mailing address

205 W MILLBROOK RD STE 205
RALEIGH NC
27609-4492
US

V. Phone/Fax

Practice location:
  • Phone: 919-781-4500
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberL0093585
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number012997
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: