Provider Demographics
NPI:1841727906
Name:GUALANDI, JEFFREY P JR
Entity type:Individual
Prefix:
First Name:JEFFREY
Middle Name:P
Last Name:GUALANDI
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7286 LAKE VIEW DR
Mailing Address - Street 2:
Mailing Address - City:AVA
Mailing Address - State:NY
Mailing Address - Zip Code:13303-1807
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:7286 LAKE VIEW DR
Practice Address - Street 2:
Practice Address - City:AVA
Practice Address - State:NY
Practice Address - Zip Code:13303-1807
Practice Address - Country:US
Practice Address - Phone:315-765-1839
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-05-18
Last Update Date:2017-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY300535164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse