Provider Demographics
NPI:1336606094
Name:JAWOROWSKI, STEPHANIE LYNN (MSACN)
Entity Type:Individual
Prefix:MISS
First Name:STEPHANIE
Middle Name:LYNN
Last Name:JAWOROWSKI
Suffix:
Gender:F
Credentials:MSACN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:66 AUSTIN BLVD
Mailing Address - Street 2:
Mailing Address - City:COMMACK
Mailing Address - State:NY
Mailing Address - Zip Code:11725-5733
Mailing Address - Country:US
Mailing Address - Phone:631-864-2784
Mailing Address - Fax:631-670-6730
Practice Address - Street 1:66 AUSTIN BLVD
Practice Address - Street 2:
Practice Address - City:COMMACK
Practice Address - State:NY
Practice Address - Zip Code:11725-5733
Practice Address - Country:US
Practice Address - Phone:631-864-2784
Practice Address - Fax:631-670-6730
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-28
Last Update Date:2019-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133N00000XDietary & Nutritional Service ProvidersNutritionistGroup - Single Specialty