Provider Demographics
NPI:1710374012
Name:SZYDLOWSKI, JESSICA D (CRNA)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:D
Last Name:SZYDLOWSKI
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1212 E MOMBASHA RD
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:NY
Mailing Address - Zip Code:10950-5615
Mailing Address - Country:US
Mailing Address - Phone:845-742-9779
Mailing Address - Fax:
Practice Address - Street 1:1212 E MOMBASHA RD
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:NY
Practice Address - Zip Code:10950-5615
Practice Address - Country:US
Practice Address - Phone:845-742-9779
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-04-24
Last Update Date:2018-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY641411367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered