Provider Demographics
NPI:1487909487
Name:SCOTT-GREAVES, JACQUELYN
Entity type:Individual
Prefix:
First Name:JACQUELYN
Middle Name:
Last Name:SCOTT-GREAVES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 NICOLE LN
Mailing Address - Street 2:
Mailing Address - City:WINGDALE
Mailing Address - State:NY
Mailing Address - Zip Code:12594-1343
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:8 NICOLE LN
Practice Address - Street 2:
Practice Address - City:WINGDALE
Practice Address - State:NY
Practice Address - Zip Code:12594-1343
Practice Address - Country:US
Practice Address - Phone:917-716-8836
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-17
Last Update Date:2012-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist