Provider Demographics
NPI:1821590753
Name:VALENTINO, JACLYN M
Entity Type:Individual
Prefix:
First Name:JACLYN
Middle Name:M
Last Name:VALENTINO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:308 SARA CIR
Mailing Address - Street 2:
Mailing Address - City:PORT JEFFERSON STATION
Mailing Address - State:NY
Mailing Address - Zip Code:11776-2739
Mailing Address - Country:US
Mailing Address - Phone:631-697-2117
Mailing Address - Fax:
Practice Address - Street 1:308 SARA CIR
Practice Address - Street 2:
Practice Address - City:PORT JEFFERSON STATION
Practice Address - State:NY
Practice Address - Zip Code:11776-2739
Practice Address - Country:US
Practice Address - Phone:631-697-2117
Practice Address - Fax:631-697-2117
Is Sole Proprietor?:No
Enumeration Date:2018-03-07
Last Update Date:2018-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist