Provider Demographics
NPI:1699956276
Name:VAUGHAN-MOSCATIELLO, JACQUELINE D (RN, BSN)
Entity type:Individual
Prefix:MRS
First Name:JACQUELINE
Middle Name:D
Last Name:VAUGHAN-MOSCATIELLO
Suffix:
Gender:F
Credentials:RN, BSN
Other - Prefix:MRS
Other - First Name:JACQUELINE
Other - Middle Name:D
Other - Last Name:MOSCATIELLO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN, BSN
Mailing Address - Street 1:16 KENT PL
Mailing Address - Street 2:
Mailing Address - City:MASTIC
Mailing Address - State:NY
Mailing Address - Zip Code:11950-2204
Mailing Address - Country:US
Mailing Address - Phone:631-399-6602
Mailing Address - Fax:631-399-6603
Practice Address - Street 1:16 KENT PL
Practice Address - Street 2:
Practice Address - City:MASTIC
Practice Address - State:NY
Practice Address - Zip Code:11950-2204
Practice Address - Country:US
Practice Address - Phone:631-399-6602
Practice Address - Fax:631-399-6603
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-23
Last Update Date:2007-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY504860163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01925002Medicaid