National Provider Identifier
Jessica Sullivan, PA
Jessica Sullivan, PA is listed in the NPPES registry with a primary specialty of Physician Assistant in Newark, NY and a listed phone number of (315) 332-2290.
Profile Overview
- NPI
- 1073849089
- Provider Type
- Individual
- Primary Specialty
- Physician Assistant
- Enumeration Date
- October 26, 2009
- Last Updated
- July 28, 2010
Practice Location
- 1200 Driving Park Ave
- Newark, NY 14513-1057
Phone: (315) 332-2290
Specialties
- Physician Assistant (363A00000X)
Full Record
- NPI
- 1073849089
- Entity Type
- Individual
- Last Name
- Sullivan
- First Name
- Jessica
- Credential
- PA
- Mailing Street Address
- 1200 Driving Park Ave
- Mailing City
- Newark
- Mailing State
- NY
- Mailing ZIP Code
- 14513-1057
- Mailing Country
- US
- Practice Street Address
- 1200 Driving Park Ave
- Practice City
- Newark
- Practice State
- NY
- Practice ZIP Code
- 14513-1057
- Practice Country
- US
- Practice Phone
- (315) 332-2290
- Enumeration Date
- October 26, 2009
- Last Updated
- July 28, 2010
- Sex
- Female
- Sole Proprietor
- No
- updated_by_file
- npidata_pfile_20050523-20260308.csv
- Taxonomies
- Physician Assistant (363A00000X)