Healthcare Provider Details

I. General information

NPI: 1104778000
Provider Name (Legal Business Name): JESSICA LINDSAY REILLY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/12/2026
Last Update Date: 06/08/2026
Certification Date: 06/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

140 WOOD RD STE 104
BRAINTREE MA
02184-2512
US

IV. Provider business mailing address

325 WASHINGTON ST
CANTON MA
02021-3857
US

V. Phone/Fax

Practice location:
  • Phone: 781-884-1539
  • Fax:
Mailing address:
  • Phone: 617-312-0653
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN2258694
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberRN2258694
License Number StateMA
# 3
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number117170-21
License Number StateNH
# 4
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number117170-23
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: