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General NPI Number Information
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NPI Number | 1750526026
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Entity Type | Individual
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Provider Name | JENNIFER BROOKE SCULLY RD
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Gender | Female
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Dates
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Enumeration Date | 12/15/2008
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Last Update Date | 12/15/2008
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Provider Practice Location Address
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Address Line | 55 PALMER AVE SODEXO- DEPT OF FOOD AND NUTRITION
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City | BRONXVILLE
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State | NY
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Zip | 10708-3403
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Country | US
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Telephone | 914-787-5089
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Fax | 914-787-5093
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Provider Business Mailing Address
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Address Line | 4705 CENTER BLVD APT 1513
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City | LONG ISLAND CITY
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State | NY
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Zip | 11109-5632
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Country | US
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Telephone | 212-729-8266
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Fax | 914-787-5093
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 133V00000X
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Taxonomy Name | Registered Dietitian
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License Number |
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License Number State |
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