Provider Demographics
NPI:1801528914
Name:MACCABE, LEE SHERIDAN (RD, LDN)
Entity type:Individual
Prefix:MR
First Name:LEE
Middle Name:SHERIDAN
Last Name:MACCABE
Suffix:
Gender:M
Credentials:RD, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:117 DRAYMORE WAY
Mailing Address - Street 2:
Mailing Address - City:CARY
Mailing Address - State:NC
Mailing Address - Zip Code:27519-8677
Mailing Address - Country:US
Mailing Address - Phone:919-757-3139
Mailing Address - Fax:
Practice Address - Street 1:120 HEALTHPLEX WAY # 220
Practice Address - Street 2:
Practice Address - City:APEX
Practice Address - State:NC
Practice Address - Zip Code:27502-8403
Practice Address - Country:US
Practice Address - Phone:919-235-6439
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-28
Last Update Date:2022-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCL005785133V00000X
86075789133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered