Provider Demographics
NPI:1437591625
Name:FRASER, JESSICA DANIELLE (PHYSICIAN ASSISTANT)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:DANIELLE
Last Name:FRASER
Suffix:
Gender:F
Credentials:PHYSICIAN ASSISTANT
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Other - Credentials:
Mailing Address - Street 1:985 MANOR LN
Mailing Address - Street 2:
Mailing Address - City:BAY SHORE
Mailing Address - State:NY
Mailing Address - Zip Code:11706-7516
Mailing Address - Country:US
Mailing Address - Phone:631-943-7516
Mailing Address - Fax:
Practice Address - Street 1:39 BRENTWOOD RD STE 101
Practice Address - Street 2:
Practice Address - City:BAY SHORE
Practice Address - State:NY
Practice Address - Zip Code:11706-8031
Practice Address - Country:US
Practice Address - Phone:631-589-7400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-07-29
Last Update Date:2019-10-16
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical