Provider Demographics
NPI:1659019149
Name:ROMANO, JESSIE ALLI (MD)
Entity Type:Individual
Prefix:
First Name:JESSIE
Middle Name:ALLI
Last Name:ROMANO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:VETERANS ADMINISTRATION
Mailing Address - Street 2:555 WILLARD AVENUE
Mailing Address - City:NEWINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06111
Mailing Address - Country:US
Mailing Address - Phone:860-808-7921
Mailing Address - Fax:860-667-6875
Practice Address - Street 1:VETERANS ADMINISTRATION
Practice Address - Street 2:555 WILLARD AVENUE
Practice Address - City:NEWINGTON
Practice Address - State:CT
Practice Address - Zip Code:06111
Practice Address - Country:US
Practice Address - Phone:860-808-7921
Practice Address - Fax:860-667-6875
Is Sole Proprietor?:No
Enumeration Date:2022-05-24
Last Update Date:2023-06-19
Deactivation Date:2023-02-22
Deactivation Code:
Reactivation Date:2023-06-19
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program