Healthcare Provider Details

I. General information

NPI: 1912817537
Provider Name (Legal Business Name): JESSICA SACCO
Entity Type: Individual
Gender:
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/08/2026
Last Update Date: 09/08/2026
Certification Date: 09/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15445 RIVERSIDE DR
WHITESTONE NY
11357-1339
US

IV. Provider business mailing address

15445 RIVERSIDE DR
WHITESTONE NY
11357-1339
US

V. Phone/Fax

Practice location:
  • Phone: 347-419-0301
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: