Healthcare Provider Details

I. General information

NPI: 1245152339
Provider Name (Legal Business Name): JORDYN DUPES
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/29/2026
Last Update Date: 07/29/2026
Certification Date: 07/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1315 S MELVILLE ST
PHILADELPHIA PA
19143-3718
US

IV. Provider business mailing address

565 CONSTITUTION DR
MIDDLETOWN PA
17057-3489
US

V. Phone/Fax

Practice location:
  • Phone: 610-600-1000
  • Fax:
Mailing address:
  • Phone: 717-798-4598
  • Fax: 717-798-4598

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: