Individual
JACLYN ROSEANN CUCCINELLO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
5225 RTE 347 STE 70, PORT JEFFERSON STATION, NY 11776-2061
(631) 331-8777
(631) 474-9169
Mailing address
5225 RTE 347 STE 70, PORT JEFFERSON STATION, NY 11776-2061
(631) 331-8777
(631) 474-9169
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
565107
NY
363LW0102X
Women's Health Nurse Practitioner
Primary
F421258-1
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
565107
—
NY
Enumeration date
08/06/2008
Last updated
07/11/2019
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