Healthcare Provider Details

I. General information

NPI: 1609789825
Provider Name (Legal Business Name): JACQUELYNN CONGDON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/28/2026
Last Update Date: 09/28/2026
Certification Date: 09/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

38 SLAWSON ST
DOLGEVILLE NY
13329-1298
US

IV. Provider business mailing address

38 SLAWSON ST
DOLGEVILLE NY
13329-1298
US

V. Phone/Fax

Practice location:
  • Phone: 315-429-3155
  • Fax: 315-429-0981
Mailing address:
  • Phone: 315-429-3155
  • Fax: 315-429-0981

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License Number945142
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: