Provider Demographics
NPI:1942634522
Name:IRELAND, JACLYN M (PA)
Entity Type:Individual
Prefix:MRS
First Name:JACLYN
Middle Name:M
Last Name:IRELAND
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Gender:F
Credentials:PA
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Mailing Address - Street 1:6620 FLY RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:EAST SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13057-9791
Mailing Address - Country:US
Mailing Address - Phone:315-464-4472
Mailing Address - Fax:315-464-5222
Practice Address - Street 1:6620 FLY RD
Practice Address - Street 2:SUITE 200
Practice Address - City:EAST SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13057-9791
Practice Address - Country:US
Practice Address - Phone:315-464-4472
Practice Address - Fax:315-464-5222
Is Sole Proprietor?:No
Enumeration Date:2013-08-30
Last Update Date:2013-08-30
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical