Provider Demographics
NPI:1942728381
Name:VALDINI, JACLYNN ELINORE (LAC)
Entity Type:Individual
Prefix:
First Name:JACLYNN
Middle Name:ELINORE
Last Name:VALDINI
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1297 BOSTON AVE
Mailing Address - Street 2:
Mailing Address - City:BAY SHORE
Mailing Address - State:NY
Mailing Address - Zip Code:11706-4717
Mailing Address - Country:US
Mailing Address - Phone:516-381-3340
Mailing Address - Fax:
Practice Address - Street 1:1297 BOSTON AVE
Practice Address - Street 2:
Practice Address - City:BAY SHORE
Practice Address - State:NY
Practice Address - Zip Code:11706-4717
Practice Address - Country:US
Practice Address - Phone:516-381-3340
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-09-06
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY005773-1171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist