Provider Demographics
NPI:1437565520
Name:LEOCATA, JACLYN N (RD)
Entity type:Individual
Prefix:
First Name:JACLYN
Middle Name:N
Last Name:LEOCATA
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:248 ROUTE 25A STE 3175
Mailing Address - Street 2:
Mailing Address - City:EAST SETAUKET
Mailing Address - State:NY
Mailing Address - Zip Code:11733-2954
Mailing Address - Country:US
Mailing Address - Phone:516-661-3318
Mailing Address - Fax:800-820-0434
Practice Address - Street 1:248 ROUTE 25A STE 3175
Practice Address - Street 2:
Practice Address - City:EAST SETAUKET
Practice Address - State:NY
Practice Address - Zip Code:11733-2954
Practice Address - Country:US
Practice Address - Phone:516-661-3318
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-07-09
Last Update Date:2024-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY007410133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered