Provider Demographics
NPI:1861904930
Name:MCGAULEY, DEMI (RDN)
Entity type:Individual
Prefix:
First Name:DEMI
Middle Name:
Last Name:MCGAULEY
Suffix:
Gender:F
Credentials:RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7865 W BELL RD # 1147
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85382-3803
Mailing Address - Country:US
Mailing Address - Phone:480-688-1779
Mailing Address - Fax:
Practice Address - Street 1:7865 W BELL RD # 1147
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85382-3803
Practice Address - Country:US
Practice Address - Phone:480-688-1779
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-10-30
Last Update Date:2024-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered