Provider Demographics
NPI:1134119118
Name:JAQUAYS, JANINE (RD,CNSD)
Entity Type:Individual
Prefix:
First Name:JANINE
Middle Name:
Last Name:JAQUAYS
Suffix:
Gender:F
Credentials:RD,CNSD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2209 GENESEE ST
Mailing Address - Street 2:
Mailing Address - City:UTICA
Mailing Address - State:NY
Mailing Address - Zip Code:13501-5930
Mailing Address - Country:US
Mailing Address - Phone:315-798-8388
Mailing Address - Fax:315-734-3444
Practice Address - Street 1:2209 GENESEE ST
Practice Address - Street 2:
Practice Address - City:UTICA
Practice Address - State:NY
Practice Address - Zip Code:13501-5930
Practice Address - Country:US
Practice Address - Phone:315-798-8388
Practice Address - Fax:315-734-3444
Is Sole Proprietor?:No
Enumeration Date:2005-10-21
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY002991-1133NN1002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYP54826Medicare UPIN
NYDD4702Medicare ID - Type UnspecifiedMEDICARE