Provider Demographics
NPI:1366677049
Name:STUART, JESSICA (MA)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:STUART
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:308 E 78TH ST
Mailing Address - Street 2:APT 14
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10075-2222
Mailing Address - Country:US
Mailing Address - Phone:941-875-2715
Mailing Address - Fax:
Practice Address - Street 1:21 7TH AVE S
Practice Address - Street 2:462 FIRST AVENUE
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10014-3902
Practice Address - Country:US
Practice Address - Phone:212-562-3296
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-05-24
Last Update Date:2009-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program