Provider Demographics
NPI:1689711871
Name:CERULLO, JAYME ROSE (NP)
Entity Type:Individual
Prefix:
First Name:JAYME
Middle Name:ROSE
Last Name:CERULLO
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:51 HERITAGE RD
Mailing Address - Street 2:
Mailing Address - City:DRACUT
Mailing Address - State:MA
Mailing Address - Zip Code:01826-4300
Mailing Address - Country:US
Mailing Address - Phone:978-957-5629
Mailing Address - Fax:
Practice Address - Street 1:20 RESEARCH PL
Practice Address - Street 2:SUITE 310
Practice Address - City:N CHELMSFORD
Practice Address - State:MA
Practice Address - Zip Code:01863-2454
Practice Address - Country:US
Practice Address - Phone:978-459-2152
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-30
Last Update Date:2008-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA235289363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAP29075Medicare UPIN
MACE NP3176Medicare ID - Type Unspecified