Provider Demographics
NPI:1114573318
Name:SKLAVER, JACLYN (MS, CNS)
Entity type:Individual
Prefix:MS
First Name:JACLYN
Middle Name:
Last Name:SKLAVER
Suffix:
Gender:F
Credentials:MS, CNS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5017 5TH ST STE 3B
Mailing Address - Street 2:
Mailing Address - City:LONG ISLAND CITY
Mailing Address - State:NY
Mailing Address - Zip Code:11101-5786
Mailing Address - Country:US
Mailing Address - Phone:212-960-8604
Mailing Address - Fax:
Practice Address - Street 1:428 E 66TH ST APT 3D
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10065-6982
Practice Address - Country:US
Practice Address - Phone:212-960-8604
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-13
Last Update Date:2019-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist