Provider Demographics
NPI:1568869527
Name:JAECKEL, KAYLA (RD)
Entity Type:Individual
Prefix:
First Name:KAYLA
Middle Name:
Last Name:JAECKEL
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 PIER POINTE ST
Mailing Address - Street 2:919F
Mailing Address - City:YONKERS
Mailing Address - State:NY
Mailing Address - Zip Code:10701-3569
Mailing Address - Country:US
Mailing Address - Phone:908-358-9720
Mailing Address - Fax:908-358-9720
Practice Address - Street 1:1 PIER POINTE ST
Practice Address - Street 2:919F
Practice Address - City:YONKERS
Practice Address - State:NY
Practice Address - Zip Code:10701-3569
Practice Address - Country:US
Practice Address - Phone:908-358-9720
Practice Address - Fax:908-358-9720
Is Sole Proprietor?:No
Enumeration Date:2014-11-19
Last Update Date:2015-09-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY1032416133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered