Jaclyn I Sholly

NPI #1225382062 in Newark, New York

Provider Information

NPI Number: 1225382062
Entity Type: Individual
Name: Jaclyn I Sholly
Gender: Not Specified
Sole Proprietor: Yes
Primary Specialty: Specialist
Enumeration Date: Nov 1, 2012
Last Updated: Nov 1, 2012

Practice Location

Address: 848 PEIRSON AVE
City: Newark
State: New York
ZIP Code: 14513-9762
Phone: (315) 331-2086

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Specialist	174400000X	Primary

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