Provider Demographics
NPI:1548595721
Name:DELIA, JACQUELINE A (RD, LDN)
Entity type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:A
Last Name:DELIA
Suffix:
Gender:F
Credentials:RD, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3312 SUGAR HOUSE ST
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27614-8485
Mailing Address - Country:US
Mailing Address - Phone:937-207-3697
Mailing Address - Fax:910-738-3764
Practice Address - Street 1:102 DODD ST
Practice Address - Street 2:
Practice Address - City:SPRING HOPE
Practice Address - State:NC
Practice Address - Zip Code:27882-9348
Practice Address - Country:US
Practice Address - Phone:252-478-4091
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-10-06
Last Update Date:2025-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCL003408133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered