Healthcare Provider Details

I. General information

NPI: 1770122368
Provider Name (Legal Business Name): JESSICA FATSIS PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: JESSICA SCHELIN OTR/L

II. Dates (important events)

Enumeration Date: 12/30/2019
Last Update Date: 03/21/2024
Certification Date: 03/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 HOSPITAL RD
PATCHOGUE NY
11772-4870
US

IV. Provider business mailing address

17 GRASSMERE AVE
OAKDALE NY
11769-1910
US

V. Phone/Fax

Practice location:
  • Phone: 631-654-7100
  • Fax:
Mailing address:
  • Phone: 631-903-2483
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number031660
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number022846
License Number StateNY

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: