Provider Demographics
NPI:1144896002
Name:MCCANN, RAYNA MOLLIE (MS, RD, CSO, CDN)
Entity type:Individual
Prefix:MRS
First Name:RAYNA
Middle Name:MOLLIE
Last Name:MCCANN
Suffix:
Gender:F
Credentials:MS, RD, CSO, CDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 BABYLON ST
Mailing Address - Street 2:
Mailing Address - City:HOLTSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11742-1203
Mailing Address - Country:US
Mailing Address - Phone:516-993-8183
Mailing Address - Fax:
Practice Address - Street 1:12 BABYLON ST
Practice Address - Street 2:
Practice Address - City:HOLTSVILLE
Practice Address - State:NY
Practice Address - Zip Code:11742-1203
Practice Address - Country:US
Practice Address - Phone:516-993-8183
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-01
Last Update Date:2021-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
86043472133V00000X, 133VN1301X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No133VN1301XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Oncology