Provider Demographics
NPI:1093859290
Name:LEGAULT, JAIME CHRISTINE
Entity Type:Individual
Prefix:MS
First Name:JAIME
Middle Name:CHRISTINE
Last Name:LEGAULT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 GREENWAY APT 5
Mailing Address - Street 2:
Mailing Address - City:MANORVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11949-3410
Mailing Address - Country:US
Mailing Address - Phone:631-909-3368
Mailing Address - Fax:
Practice Address - Street 1:5 GREENWAY APT 5
Practice Address - Street 2:
Practice Address - City:MANORVILLE
Practice Address - State:NY
Practice Address - Zip Code:11949-3410
Practice Address - Country:US
Practice Address - Phone:631-909-3368
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-19
Last Update Date:2022-07-21
Deactivation Date:2007-03-19
Deactivation Code:
Reactivation Date:2012-09-11
Provider Licenses
StateLicense IDTaxonomies
NY174H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174H00000XOther Service ProvidersHealth Educator