Individual
JACQUELINE MARIE SQUILLACIOTI
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
407 BAYPORT AVE, BAYPORT, NY 11705-1405
(516) 356-8426
Mailing address
407 BAYPORT AVE, BAYPORT, NY 11705-1405
(516) 356-8426
Taxonomy
Speciality
Code
Description
License number
State
252Y00000X
Early Intervention Provider Agency
Primary
—
—
Other
Enumeration date
11/14/2018
Last updated
11/14/2018
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