Provider Demographics
NPI:1437499761
Name:SVARAL, JACLYN P
Entity Type:Individual
Prefix:MRS
First Name:JACLYN
Middle Name:P
Last Name:SVARAL
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 1:87 PRENTICE RD
Mailing Address - Street 2:
Mailing Address - City:LEVITTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:11756-5221
Mailing Address - Country:US
Mailing Address - Phone:516-622-5941
Mailing Address - Fax:
Practice Address - Street 1:87 PRENTICE RD
Practice Address - Street 2:
Practice Address - City:LEVITTOWN
Practice Address - State:NY
Practice Address - Zip Code:11756-5221
Practice Address - Country:US
Practice Address - Phone:516-622-5941
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-23
Last Update Date:2013-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1176890252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency