Provider Demographics
NPI:1134901531
Name:UGUIL, JESSA BHEL ARRICIVITA
Entity type:Individual
Prefix:
First Name:JESSA BHEL
Middle Name:ARRICIVITA
Last Name:UGUIL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:JESSA BHEL
Other - Middle Name:MANECLANG
Other - Last Name:ARRICIVITA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2 JODY CT
Mailing Address - Street 2:
Mailing Address - City:SHOREHAM
Mailing Address - State:NY
Mailing Address - Zip Code:11786-2200
Mailing Address - Country:US
Mailing Address - Phone:646-520-7493
Mailing Address - Fax:
Practice Address - Street 1:1116 MAIN RD
Practice Address - Street 2:
Practice Address - City:RIVERHEAD
Practice Address - State:NY
Practice Address - Zip Code:11901-5724
Practice Address - Country:US
Practice Address - Phone:631-722-2170
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-19
Last Update Date:2023-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty