Provider Demographics
NPI:1558648733
Name:DUQUETTE, JACQUELYNN SCHULTZ (NPP)
Entity Type:Individual
Prefix:MS
First Name:JACQUELYNN
Middle Name:SCHULTZ
Last Name:DUQUETTE
Suffix:
Gender:F
Credentials:NPP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:SUNY UPSTATE CHILD AND ADOLESCENT PSYCHIATRY CLINIC
Mailing Address - Street 2:713 HARRISON STREET
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13210-2017
Mailing Address - Country:US
Mailing Address - Phone:315-464-4976
Mailing Address - Fax:315-464-3202
Practice Address - Street 1:SUNY UPSTATE CHILD AND ADOLESCENT PSYCHIATRY CLINIC
Practice Address - Street 2:713 HARRISON STREET
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13210
Practice Address - Country:US
Practice Address - Phone:315-464-4976
Practice Address - Fax:315-464-3202
Is Sole Proprietor?:No
Enumeration Date:2011-11-15
Last Update Date:2019-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY401388363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health