Healthcare Provider Details

I. General information

NPI: 1013673656
Provider Name (Legal Business Name): JILLIAN CASTELLANI PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/09/2021
Last Update Date: 06/08/2022
Certification Date: 06/08/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1240 S CEDAR CREST BLVD STE 401
ALLENTOWN PA
18103-6218
US

IV. Provider business mailing address

1605 N CEDAR CREST BLVD STE 411
ALLENTOWN PA
18104-2323
US

V. Phone/Fax

Practice location:
  • Phone: 610-402-7880
  • Fax: 610-402-7881
Mailing address:
  • Phone: 484-330-1377
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberMA063175
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: