MEDICARE: JESSICA LEIGH TROXELL

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

General Provider Information

NPI Number	:	1609742444
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JESSICA LEIGH TROXELL

Provider Business Mailing Address
First Line	:	100 NICOLLS RD
Second Line	:	HSC T12 RM 080
City	:	STONY BROOK
State	:	NY
Zip	:	11794-8122
Country	:	US
Telephone Number	:	631-444-8070
Fax Number	:	631-865-1192

Provider Business Practice Location Address
First Line	:	100 NICOLLS RD
Second Line	:	HSC T12 RM 080
City	:	STONY BROOK
State	:	NY
Zip	:	11794-8122
Country	:	US
Telephone Number	:	631-444-8070
Fax Number	:	631-865-1192

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

Provider Enumeration Date	:	10/16/2025
Last Update Date	:	01/07/2026

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