Healthcare Provider Details

I. General information

NPI: 1972435634
Provider Name (Legal Business Name): MICHELLE A JESKI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/29/2026
Last Update Date: 05/29/2026
Certification Date: 05/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

750 E ADAMS ST
SYRACUSE NY
13210-1834
US

IV. Provider business mailing address

2604 ROLLING HILLS RD
CAMILLUS NY
13031-9605
US

V. Phone/Fax

Practice location:
  • Phone: 315-464-1480
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SP0200X
TaxonomyPediatric Clinical Nurse Specialist
License Number543514
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: