Provider Demographics
NPI:1083368203
Name:COSTANTINO, JERILYN ELIZABETH (RN BSN)
Entity Type:Individual
Prefix:MRS
First Name:JERILYN
Middle Name:ELIZABETH
Last Name:COSTANTINO
Suffix:
Gender:F
Credentials:RN BSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:5130 E MAIN STREET RD
Mailing Address - Street 2:
Mailing Address - City:BATAVIA
Mailing Address - State:NY
Mailing Address - Zip Code:14020-3444
Mailing Address - Country:US
Mailing Address - Phone:585-344-1421
Mailing Address - Fax:585-345-3080
Practice Address - Street 1:5130 E MAIN STREET RD
Practice Address - Street 2:
Practice Address - City:BATAVIA
Practice Address - State:NY
Practice Address - Zip Code:14020-3444
Practice Address - Country:US
Practice Address - Phone:585-344-1421
Practice Address - Fax:585-345-3080
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-07
Last Update Date:2022-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY424050163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health