Provider Demographics
NPI:1356821425
Name:MCCULLOUGH, MINDY (RD)
Entity Type:Individual
Prefix:
First Name:MINDY
Middle Name:
Last Name:MCCULLOUGH
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:108 COATBRIDGE CIR
Mailing Address - Street 2:
Mailing Address - City:CARY
Mailing Address - State:NC
Mailing Address - Zip Code:27511-5088
Mailing Address - Country:US
Mailing Address - Phone:814-762-4407
Mailing Address - Fax:
Practice Address - Street 1:3900 BROWNING PL
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27609-6508
Practice Address - Country:US
Practice Address - Phone:919-781-9650
Practice Address - Fax:919-781-3572
Is Sole Proprietor?:No
Enumeration Date:2018-08-17
Last Update Date:2018-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered