Basic Information
| Provider Information | |||||||||
| NPI: | 1477117513 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | JACQUET | ||||||||
| FirstName: | SABRIELLA | ||||||||
| MiddleName: | YVES-ROSE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 544-950 NOTRE DAME WEST | ||||||||
| Address2: | |||||||||
| City: | MONTREAL | ||||||||
| State: | QUEBEC | ||||||||
| PostalCode: | H3C0K | ||||||||
| CountryCode: | CA | ||||||||
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| Practice Location | |||||||||
| Address1: | 622 W 168TH ST PH 4-124 | ||||||||
| Address2: | |||||||||
| City: | NEW YORK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 100323720 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2123058207 | ||||||||
| FaxNumber: | 2123056692 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/24/2019 | ||||||||
| LastUpdateDate: | 07/21/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | Y | Student, Health Care | Student in an Organized Health Care Education/Training Program |
No ID Information.