Healthcare Provider Details

I. General information

NPI: 1144536533
Provider Name (Legal Business Name): JULIE ANN FARRELL RD, PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/24/2010
Last Update Date: 04/24/2026
Certification Date: 04/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1581 N 9TH ST
STROUDSBURG PA
18360-7531
US

IV. Provider business mailing address

1581 N 9TH ST
STROUDSBURG PA
18360-7531
US

V. Phone/Fax

Practice location:
  • Phone: 484-426-2600
  • Fax: 610-336-4379
Mailing address:
  • Phone: 484-426-2600
  • Fax: 610-336-4379

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberMA059487
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number25MP00373600
License Number StateNJ
# 3
Primary TaxonomyN
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberNU60172448
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: