Provider Demographics
NPI:1003421132
Name:RAYNOR, MICHAEL (MS, RD, LDN)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:RAYNOR
Suffix:
Gender:M
Credentials:MS, RD, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1441 E BROAD ST STE 256
Mailing Address - Street 2:
Mailing Address - City:FUQUAY VARINA
Mailing Address - State:NC
Mailing Address - Zip Code:27526-1968
Mailing Address - Country:US
Mailing Address - Phone:919-741-0730
Mailing Address - Fax:
Practice Address - Street 1:1441 E BROAD ST STE 256
Practice Address - Street 2:
Practice Address - City:FUQUAY VARINA
Practice Address - State:NC
Practice Address - Zip Code:27526-1968
Practice Address - Country:US
Practice Address - Phone:919-741-0730
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-15
Last Update Date:2022-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered