Individual
MRS. JACLYN ELENA BANNISTER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.S. SP ED
Contact information
Practice address
3055 71ST ST, #1, EAST ELMHURST, NY 11370-1412
(347) 556-4013
Mailing address
3055 71ST ST, #1, EAST ELMHURST, NY 11370-1412
(347) 556-4013
Taxonomy
Speciality
Code
Description
License number
State
171W00000X
Contractor
Primary
445735
NY
Other
Enumeration date
04/15/2014
Last updated
04/15/2014
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