Provider Demographics
NPI:1881030245
Name:DONNELLY, JILLIAN ROSE (DO)
Entity Type:Individual
Prefix:DR
First Name:JILLIAN
Middle Name:ROSE
Last Name:DONNELLY
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:JILLIAN
Other - Middle Name:ROSE
Other - Last Name:SCAMBIA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:PO BOX 911057
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80291-1057
Mailing Address - Country:US
Mailing Address - Phone:888-269-7001
Mailing Address - Fax:303-764-6640
Practice Address - Street 1:1 MILL RIVER LN APT 105
Practice Address - Street 2:
Practice Address - City:ARDSLEY
Practice Address - State:NY
Practice Address - Zip Code:10502
Practice Address - Country:US
Practice Address - Phone:914-879-9889
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-13
Last Update Date:2019-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODR.0061017208800000X
NY300483208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology