Provider Demographics
NPI:1265702617
Name:DALOIA, JACLYN (MS)
Entity type:Individual
Prefix:MRS
First Name:JACLYN
Middle Name:
Last Name:DALOIA
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:JACLYN
Other - Middle Name:
Other - Last Name:D'ALOIA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:146 GETTLE RD
Mailing Address - Street 2:
Mailing Address - City:AVERILL PARK
Mailing Address - State:NY
Mailing Address - Zip Code:12018-9794
Mailing Address - Country:US
Mailing Address - Phone:518-674-7068
Mailing Address - Fax:
Practice Address - Street 1:146 GETTLE RD
Practice Address - Street 2:
Practice Address - City:AVERILL PARK
Practice Address - State:NY
Practice Address - Zip Code:12018-9794
Practice Address - Country:US
Practice Address - Phone:518-674-7068
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-01-03
Last Update Date:2012-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY498391041235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01379024Medicaid