MEDICARE: MS. JILL A STEIDL PA-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	PA2004-0007	NM
2	363AM0700X	Medical Physician Assistant	PA2004-0007	NM
3	363A00000X	Physician Assistant	023977	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1316944143
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. JILL A STEIDL PA-C

Provider Business Mailing Address
First Line	:	750 E ADAMS ST
Second Line	:
City	:	SYRACUSE
State	:	NY
Zip	:	13210-2306
Country	:	US
Telephone Number	:	315-464-8093
Fax Number	:	315-464-8333

Provider Business Practice Location Address
First Line	:	90 PRESIDENTIAL PLZ
Second Line	:
City	:	SYRACUSE
State	:	NY
Zip	:	13202-2240
Country	:	US
Telephone Number	:	315-464-3836
Fax Number	:	315-464-3837

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/07/2005
Last Update Date	:	05/13/2022

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Directions to “ MS. JILL A STEIDL PA-C” Practice Location

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