Provider Demographics
NPI:1972219236
Name:VINGAN, JACLYN (MPH, RD, CDN, IBCLC)
Entity Type:Individual
Prefix:
First Name:JACLYN
Middle Name:
Last Name:VINGAN
Suffix:
Gender:F
Credentials:MPH, RD, CDN, IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3154 29TH ST APT 1R
Mailing Address - Street 2:
Mailing Address - City:ASTORIA
Mailing Address - State:NY
Mailing Address - Zip Code:11106-3342
Mailing Address - Country:US
Mailing Address - Phone:631-561-8944
Mailing Address - Fax:
Practice Address - Street 1:3154 29TH ST APT 1R
Practice Address - Street 2:
Practice Address - City:ASTORIA
Practice Address - State:NY
Practice Address - Zip Code:11106-3342
Practice Address - Country:US
Practice Address - Phone:631-561-8944
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-30
Last Update Date:2023-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RN
No133V00000XDietary & Nutritional Service ProvidersDietitian, Registered