Healthcare Provider Details

I. General information

NPI: 1881620623
Provider Name (Legal Business Name): JEFFREY P DONNELLY PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/23/2006
Last Update Date: 02/03/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

516 STRAND ST FREDERIKSTED HEALTH CENTER
FREDERIKSTED VI
00840-3533
US

IV. Provider business mailing address

PO BOX 24863
CHRISTIANSTED VI
00824-0863
US

V. Phone/Fax

Practice location:
  • Phone: 340-772-0260
  • Fax:
Mailing address:
  • Phone: 340-642-5460
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number060
License Number StateVI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: