Healthcare Provider Details

I. General information

NPI: 1023950193
Provider Name (Legal Business Name): JESSICA ANNA SANTANIELLO PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/08/2026
Last Update Date: 07/06/2026
Certification Date: 07/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 DUDLEY ST STE 360
PROVIDENCE RI
02905-3248
US

IV. Provider business mailing address

63 CHAREST LN
AGAWAM MA
01001-3671
US

V. Phone/Fax

Practice location:
  • Phone: 401-274-7546
  • Fax:
Mailing address:
  • Phone: 413-523-2169
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA01930
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: