Healthcare Provider Details

I. General information

NPI: 1861813198
Provider Name (Legal Business Name): JORDAN SIGNORELLI
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/06/2014
Last Update Date: 09/30/2026
Certification Date: 09/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5000 RESEARCH CT STE 450
SUWANEE GA
30024-6660
US

IV. Provider business mailing address

5000 RESEARCH CT STE 450
SUWANEE GA
30024-6660
US

V. Phone/Fax

Practice location:
  • Phone: 770-205-5551
  • Fax:
Mailing address:
  • Phone: 516-776-2106
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number021127-1
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number6869
License Number StateAZ
# 3
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOT009190
License Number StateGA
# 4
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number18141
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: