Provider Demographics
NPI:1417402652
Name:RESO, JESSICA (PA-C)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:RESO
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:
Other - Last Name:MESIDOR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:85 SEYMOUR ST STE 919
Mailing Address - Street 2:
Mailing Address - City:HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06106-5528
Mailing Address - Country:US
Mailing Address - Phone:860-696-5520
Mailing Address - Fax:860-522-3951
Practice Address - Street 1:85 SEYMOUR ST STE 919
Practice Address - Street 2:
Practice Address - City:HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06106-5528
Practice Address - Country:US
Practice Address - Phone:860-696-5520
Practice Address - Fax:860-522-3951
Is Sole Proprietor?:No
Enumeration Date:2016-08-17
Last Update Date:2021-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY020023363AS0400X
CT5170363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY020023OtherNYS LICENSE