Provider Demographics
NPI:1508209032
Name:ARNETT, JACQUELINE (RD)
Entity Type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:
Last Name:ARNETT
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:JACKIE
Other - Middle Name:
Other - Last Name:ARNETT
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RD
Mailing Address - Street 1:62 MUTTONTOWN EASTWOODS RD
Mailing Address - Street 2:
Mailing Address - City:SYOSSET
Mailing Address - State:NY
Mailing Address - Zip Code:11791-2401
Mailing Address - Country:US
Mailing Address - Phone:917-535-3626
Mailing Address - Fax:
Practice Address - Street 1:358 JERICHO TPKE
Practice Address - Street 2:
Practice Address - City:SYOSSET
Practice Address - State:NY
Practice Address - Zip Code:11791-4544
Practice Address - Country:US
Practice Address - Phone:917-535-3626
Practice Address - Fax:516-977-3367
Is Sole Proprietor?:No
Enumeration Date:2013-04-15
Last Update Date:2013-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY86011038133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered