MEDICARE: JENNIFER LYNN SITTAMBALAM PA

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	:	1922797349
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER LYNN SITTAMBALAM PA

Provider Business Mailing Address
First Line	:	422 EAST ST
Second Line	:
City	:	BROCKTON
State	:	MA
Zip	:	02302-4134
Country	:	US
Telephone Number	:	860-751-4339
Fax Number	:

Provider Business Practice Location Address
First Line	:	26 THOMSON PL
Second Line	:
City	:	BOSTON
State	:	MA
Zip	:	02210-1212
Country	:	US
Telephone Number	:	888-663-6331
Fax Number	:	415-252-7176

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

Provider Enumeration Date	:	05/02/2023
Last Update Date	:	02/10/2026

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