Healthcare Provider Details

I. General information

NPI: 1235574211
Provider Name (Legal Business Name): JESSICA ANN NEELY M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/06/2013
Last Update Date: 02/28/2025
Certification Date: 02/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

550 16TH ST FL 6
SAN FRANCISCO CA
94158-2604
US

IV. Provider business mailing address

291 SCENIC AVE
PIEDMONT CA
94611-3416
US

V. Phone/Fax

Practice location:
  • Phone: 415-353-7337
  • Fax:
Mailing address:
  • Phone: 270-748-0233
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA135283
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code2080P0216X
TaxonomyPediatric Rheumatology Physician
License NumberA135283
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: