Healthcare Provider Details

I. General information

NPI: 1851256002
Provider Name (Legal Business Name): JESSICA DELGUERCIO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/19/2025
Last Update Date: 12/19/2025
Certification Date: 12/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

481 E RIVER DR
LAKE LUZERNE NY
12846-1912
US

IV. Provider business mailing address

481 E RIVER DR
LAKE LUZERNE NY
12846-1912
US

V. Phone/Fax

Practice location:
  • Phone: 917-359-0515
  • Fax:
Mailing address:
  • Phone: 917-359-0515
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: