Provider Demographics
NPI:1760634422
Name:RAY, STACEY R (RD)
Entity type:Individual
Prefix:
First Name:STACEY
Middle Name:R
Last Name:RAY
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:STACEY
Other - Middle Name:R
Other - Last Name:GIDEON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1515 SW CARY PKWY
Mailing Address - Street 2:SUITE 200
Mailing Address - City:CARY
Mailing Address - State:NC
Mailing Address - Zip Code:27511-6224
Mailing Address - Country:US
Mailing Address - Phone:919-387-3200
Mailing Address - Fax:919-387-3201
Practice Address - Street 1:1515 SW CARY PKWY
Practice Address - Street 2:SUITE 200
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27511-6224
Practice Address - Country:US
Practice Address - Phone:919-387-3200
Practice Address - Fax:919-387-3201
Is Sole Proprietor?:No
Enumeration Date:2008-10-14
Last Update Date:2008-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered