Provider Demographics
NPI:1871826701
Name:PREVELIGE, JASON PAUL (PA-C)
Entity Type:Individual
Prefix:MR
First Name:JASON
Middle Name:PAUL
Last Name:PREVELIGE
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
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Mailing Address - Street 1:56 FRANKLIN ST
Mailing Address - Street 2:
Mailing Address - City:WATERBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06706-1221
Mailing Address - Country:US
Mailing Address - Phone:203-709-8873
Mailing Address - Fax:203-709-8689
Practice Address - Street 1:56 FRANKLIN ST
Practice Address - Street 2:
Practice Address - City:WATERBURY
Practice Address - State:CT
Practice Address - Zip Code:06706-1221
Practice Address - Country:US
Practice Address - Phone:203-709-6004
Practice Address - Fax:203-709-3700
Is Sole Proprietor?:No
Enumeration Date:2009-09-10
Last Update Date:2022-09-22
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CT002305363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical