Individual
JAQUALYN IARDELLA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
370 VIOLET AVE, POUGHKEEPSIE, NY 12601-1034
(845) 471-1807
Mailing address
370 VIOLET AVE, POUGHKEEPSIE, NY 12601-1034
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
—
—
163W00000X
Registered Nurse
817212
NY
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
406679
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01420800
—
NY
01
—
10400Y
MEDICARE PAN
MA
Enumeration date
06/04/2015
Last updated
05/08/2025
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