Provider Demographics
NPI:1912148271
Name:SACCOCCIA, AMY J (RD, LDN)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:J
Last Name:SACCOCCIA
Suffix:
Gender:F
Credentials:RD, LDN
Other - Prefix:
Other - First Name:AMY
Other - Middle Name:
Other - Last Name:JONS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2000 PERIMETER PARK DR STE 200
Mailing Address - Street 2:
Mailing Address - City:MORRISVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27560-8442
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:10208 CERNY ST STE 110
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27617-7885
Practice Address - Country:US
Practice Address - Phone:984-215-4590
Practice Address - Fax:984-215-4591
Is Sole Proprietor?:No
Enumeration Date:2009-03-17
Last Update Date:2021-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCL000790133N00000X
NC800728133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No133N00000XDietary & Nutritional Service ProvidersNutritionist