Healthcare Provider Details

I. General information

NPI: 1801707765
Provider Name (Legal Business Name): JAYCIE WATSON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/16/2026
Last Update Date: 09/16/2026
Certification Date: 09/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

145 MAIN ST
DELHI NY
13753-1282
US

IV. Provider business mailing address

145 MAIN ST
DELHI NY
13753-1282
US

V. Phone/Fax

Practice location:
  • Phone: 607-746-3570
  • Fax:
Mailing address:
  • Phone: 607-746-3570
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License NumberCRPA-6769
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: