Gannon, Jacklyn

Gannon, Jacklyn is an sole proprietor health care provider with primary practice located at 101 Nicolls Rd , Stony Brook NY 11794-0001. She recently has 2 registered licenses in different health care specialties including Nursing Service Providers / Emergency, Physician Assistants & Advanced Practice Nursing Providers / Psychiatric/Mental Health. Physician Assistants & Advanced Practice Nursing Providers / Psychiatric/Mental Health is her primary health care specialty. Gannon, Jacklyn can be contacted via phone (631) 638-1036.

Contact Information

Primary practice address
101 Nicolls Rd Stony Brook NY 11794-0001
Phone: (631) 638-1036
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Nursing Service Providers / Emergency 163WE0003X 745153 New York
Physician Assistants & Advanced Practice Nursing Providers / Psychiatric/Mental Health 363LP0808X 405347 New York

Profile Details

NPI number 1841078359
LBN Legal business name Gannon, Jacklyn
Credentials
Entity Individual
Sole proprietor 1 Yes
Enumeration date Sep 18th, 2023
Last updated Oct 10th, 2023 - about last year

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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