Healthcare Provider Details

I. General information

NPI: 1184407124
Provider Name (Legal Business Name): JESSICA CUEVA-SCARPELLI
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/15/2023
Last Update Date: 08/15/2023
Certification Date: 08/15/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

710 6TH AVE UNIT 204
ASBURY PARK NJ
07712-5355
US

IV. Provider business mailing address

710 6TH AVE UNIT 204
ASBURY PARK NJ
07712-5355
US

V. Phone/Fax

Practice location:
  • Phone: 845-248-7363
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number25MP00802900
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: