Provider Demographics
NPI:1164818605
Name:ZITO, JACLYN MICHELLE (PA-C)
Entity Type:Individual
Prefix:
First Name:JACLYN
Middle Name:MICHELLE
Last Name:ZITO
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Gender:F
Credentials:PA-C
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Mailing Address - Street 1:STONY BROOK UNIVERSITY HOSPITAL, NEUROLOGY HSC 12-020
Mailing Address - Street 2:101 NICOLLS RD
Mailing Address - City:STONY BROOK
Mailing Address - State:NY
Mailing Address - Zip Code:11794-0001
Mailing Address - Country:US
Mailing Address - Phone:631-444-8397
Mailing Address - Fax:631-444-1474
Practice Address - Street 1:STONY BROOK UNIVERSITY HOSPITAL
Practice Address - Street 2:101 NICOLLS RD
Practice Address - City:STONY BROOK
Practice Address - State:NY
Practice Address - Zip Code:11794-0001
Practice Address - Country:US
Practice Address - Phone:631-444-8397
Practice Address - Fax:631-444-1474
Is Sole Proprietor?:No
Enumeration Date:2015-04-10
Last Update Date:2022-04-26
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Provider Licenses
StateLicense IDTaxonomies
NY018474363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant