Healthcare Provider Details

I. General information

NPI: 1508681693
Provider Name (Legal Business Name): JILLIAN LEE BIELLO PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/22/2024
Last Update Date: 02/24/2026
Certification Date: 02/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

132 OLD RIVER RD. SUITE 108
LINCOLN RI
02865-1397
US

IV. Provider business mailing address

132 OLD RIVER RD. SUITE 108
LINCOLN RI
02865-1397
US

V. Phone/Fax

Practice location:
  • Phone: 401-723-9250
  • Fax:
Mailing address:
  • Phone: 401-723-9250
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number0010-15123
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: