Provider Demographics
NPI:1386971109
Name:MACCURRACH, MEGHANN WINSLOW (RD, LD, CLC)
Entity type:Individual
Prefix:MISS
First Name:MEGHANN
Middle Name:WINSLOW
Last Name:MACCURRACH
Suffix:
Gender:F
Credentials:RD, LD, CLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2313 E 28TH AVE
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33605-1333
Mailing Address - Country:US
Mailing Address - Phone:813-307-8015
Mailing Address - Fax:813-272-5408
Practice Address - Street 1:2313 E 28TH AVE
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33605-1333
Practice Address - Country:US
Practice Address - Phone:813-307-8015
Practice Address - Fax:813-272-5408
Is Sole Proprietor?:No
Enumeration Date:2009-11-16
Last Update Date:2010-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLND 5629133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered