Provider Demographics
NPI:1467069187
Name:SCHNEIDER, JACLYN (RD)
Entity Type:Individual
Prefix:
First Name:JACLYN
Middle Name:
Last Name:SCHNEIDER
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:313 E PALMETTO PARK RD APT 412
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33432-5159
Mailing Address - Country:US
Mailing Address - Phone:561-213-7277
Mailing Address - Fax:561-431-8201
Practice Address - Street 1:313 E PALMETTO PARK RD APT 412
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33432-5159
Practice Address - Country:US
Practice Address - Phone:561-213-7277
Practice Address - Fax:561-431-8201
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-27
Last Update Date:2022-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY86099415133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered