Healthcare Provider Details

I. General information

NPI: 1265340301
Provider Name (Legal Business Name): JACLYN ROSE GIORGIONE HYG
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2026
Last Update Date: 08/31/2026
Certification Date: 08/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6341 RIDGE RD
SODUS NY
14551-9743
US

IV. Provider business mailing address

601B W WASHINGTON ST
GENEVA NY
14456-2119
US

V. Phone/Fax

Practice location:
  • Phone: 315-483-1199
  • Fax:
Mailing address:
  • Phone: 315-787-8151
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number033914
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: