Healthcare Provider Details

I. General information

NPI: 1821831678
Provider Name (Legal Business Name): JENNIFER IRENE DEASY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/18/2024
Last Update Date: 05/05/2026
Certification Date: 05/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

STAR COMMUNITY HEALTH KIDSCARE - SIGAL CENTER 450 WEST CHEW STREET, SUITE 203
ALLENTOWN PA
18102
US

IV. Provider business mailing address

ST. LUKE'S UNIVERSITY HEALTH NETWORK - ANDERSON MEDICAL EDUCATION OFFICE, 1700 ST. LUKE'S BLVD
EASTON PA
18045
US

V. Phone/Fax

Practice location:
  • Phone: 484-822-7850
  • Fax:
Mailing address:
  • Phone: 866-785-8537
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMT236396
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: