Provider Demographics
NPI:1265152854
Name:REILLY, JAYCEE ANN (RD)
Entity type:Individual
Prefix:
First Name:JAYCEE
Middle Name:ANN
Last Name:REILLY
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 1:101 DONALD ROSS DR
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27610-2593
Mailing Address - Country:US
Mailing Address - Phone:919-250-3320
Mailing Address - Fax:
Practice Address - Street 1:101 DONALD ROSS DR
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27610-2593
Practice Address - Country:US
Practice Address - Phone:919-250-3320
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-01
Last Update Date:2022-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCL006991133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered