Provider Demographics
NPI:1831639624
Name:MCCAHAN, STACIA (RD,LD/N)
Entity Type:Individual
Prefix:
First Name:STACIA
Middle Name:
Last Name:MCCAHAN
Suffix:
Gender:F
Credentials:RD,LD/N
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2380 3RD ST S
Mailing Address - Street 2:SUITE #1
Mailing Address - City:JACKSONVILLE BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32250-4072
Mailing Address - Country:US
Mailing Address - Phone:904-270-1234
Mailing Address - Fax:
Practice Address - Street 1:2380 3RD ST S
Practice Address - Street 2:SUITE #1
Practice Address - City:JACKSONVILLE BEACH
Practice Address - State:FL
Practice Address - Zip Code:32250-4072
Practice Address - Country:US
Practice Address - Phone:904-270-1234
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-02-28
Last Update Date:2022-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLND 8075133V00000X
FLIMH21568101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health