Provider Demographics
NPI:1750526026
Name:SCULLY, JENNIFER BROOKE (RD)
Entity type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:BROOKE
Last Name:SCULLY
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:4705 CENTER BLVD
Mailing Address - Street 2:APT 1513
Mailing Address - City:LONG ISLAND CITY
Mailing Address - State:NY
Mailing Address - Zip Code:11109-5632
Mailing Address - Country:US
Mailing Address - Phone:212-729-8266
Mailing Address - Fax:914-787-5093
Practice Address - Street 1:55 PALMER AVE
Practice Address - Street 2:SODEXO- DEPT OF FOOD AND NUTRITION
Practice Address - City:BRONXVILLE
Practice Address - State:NY
Practice Address - Zip Code:10708-3403
Practice Address - Country:US
Practice Address - Phone:914-787-5089
Practice Address - Fax:914-787-5093
Is Sole Proprietor?:No
Enumeration Date:2008-12-15
Last Update Date:2008-12-15
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered