Provider Demographics
NPI:1477746865
Name:PAVELING, JACQUELINE GRACE (NP)
Entity Type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:GRACE
Last Name:PAVELING
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:UNIVERSITY MEDICAL CENTER STONY BRK
Mailing Address - Street 2:STONY BROOK HOSPITAL, DEPT MEDICINE, HOSPITAL 15N-082
Mailing Address - City:STONY BROOK
Mailing Address - State:NY
Mailing Address - Zip Code:11794-8160
Mailing Address - Country:US
Mailing Address - Phone:631-444-3318
Mailing Address - Fax:631-444-1235
Practice Address - Street 1:UNIVERSITY MEDICAL CENTER STONY BRK
Practice Address - Street 2:STONY BROOK HOSPITAL, DEPT MEDICINE, HOSPITAL 15N-082
Practice Address - City:STONY BROOK
Practice Address - State:NY
Practice Address - Zip Code:11794-8160
Practice Address - Country:US
Practice Address - Phone:631-444-3318
Practice Address - Fax:631-444-1235
Is Sole Proprietor?:No
Enumeration Date:2007-08-20
Last Update Date:2014-03-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NYF300620363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner