Healthcare Provider Details

I. General information

NPI: 1558274472
Provider Name (Legal Business Name): LYDIA OCBU RDN, LDN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/23/2026
Last Update Date: 09/23/2026
Certification Date: 09/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9216 BAILEYWICK RD
RALEIGH NC
27615-1907
US

IV. Provider business mailing address

9216 BAILEYWICK RD
RALEIGH NC
27615-1907
US

V. Phone/Fax

Practice location:
  • Phone: 704-380-4655
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberL010353
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: