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General NPI Number Information
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NPI Number | 1760905699
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Entity Type | Individual
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Provider Name | JACQUELYN KATE CHENELLE PA-C
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Gender | Female
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Dates
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Enumeration Date | 07/23/2017
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Last Update Date | 01/24/2025
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Provider Practice Location Address
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Address Line | 2000 WASHINGTON ST
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City | NEWTON
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State | MA
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Zip | 02462-1650
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Country | US
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Telephone | 617-969-1227
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Fax |
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Provider Business Mailing Address
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Address Line | 8 MAPLEHURST RD
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City | LITTLETON
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State | MA
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Zip | 01460-1972
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Country | US
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Telephone | 978-496-6158
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | PA6184
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License Number State | MA
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Taxonomy #2
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Taxonomy Code | 207RG0100X
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Taxonomy Name | Gastroenterology Physician
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License Number | PA6184
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License Number State | MA
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