Healthcare Provider Details

I. General information

NPI: 1134119118
Provider Name (Legal Business Name): JANINE JAQUAYS RD,CNSD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/21/2005
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2209 GENESEE ST
UTICA NY
13501-5930
US

IV. Provider business mailing address

2209 GENESEE ST
UTICA NY
13501-5930
US

V. Phone/Fax

Practice location:
  • Phone: 315-798-8388
  • Fax: 315-734-3444
Mailing address:
  • Phone: 315-798-8388
  • Fax: 315-734-3444

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133NN1002X
TaxonomyNutrition Education Nutritionist
License Number002991-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: