Provider Demographics
NPI:1407331622
Name:MCCAHILL, JENNIFER ALYSSA
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:ALYSSA
Last Name:MCCAHILL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:107 MILLERS RUN
Mailing Address - Street 2:
Mailing Address - City:MILLSBORO
Mailing Address - State:DE
Mailing Address - Zip Code:19966-1606
Mailing Address - Country:US
Mailing Address - Phone:302-745-2006
Mailing Address - Fax:
Practice Address - Street 1:29786 JOHN J WILLIAMS HWY UNIT 3
Practice Address - Street 2:
Practice Address - City:MILLSBORO
Practice Address - State:DE
Practice Address - Zip Code:19966-4099
Practice Address - Country:US
Practice Address - Phone:302-440-5855
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-03
Last Update Date:2018-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DE2018604829246ZA2600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZA2600XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherArt, Medical