Provider Demographics
NPI:1376831420
Name:YACONO, JEAN MURIEL (NPP)
Entity type:Individual
Prefix:
First Name:JEAN
Middle Name:MURIEL
Last Name:YACONO
Suffix:
Gender:F
Credentials:NPP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:525 CONVENT RD
Mailing Address - Street 2:
Mailing Address - City:SYOSSET
Mailing Address - State:NY
Mailing Address - Zip Code:11791-3868
Mailing Address - Country:US
Mailing Address - Phone:516-921-0808
Mailing Address - Fax:
Practice Address - Street 1:525 CONVENT RD
Practice Address - Street 2:
Practice Address - City:SYOSSET
Practice Address - State:NY
Practice Address - Zip Code:11791-3868
Practice Address - Country:US
Practice Address - Phone:516-921-0808
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-07-11
Last Update Date:2011-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF400182-1363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health