Provider Demographics
NPI:1295079036
Name:SCHLUSSEL, JESSICA (RPA-C)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:SCHLUSSEL
Suffix:
Gender:F
Credentials:RPA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21008 NORTHERN BLVD STE 2
Mailing Address - Street 2:
Mailing Address - City:BAYSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11361-3211
Mailing Address - Country:US
Mailing Address - Phone:718-224-8200
Mailing Address - Fax:718-819-0244
Practice Address - Street 1:21008 NORTHERN BLVD STE 2
Practice Address - Street 2:
Practice Address - City:BAYSIDE
Practice Address - State:NY
Practice Address - Zip Code:11361-3211
Practice Address - Country:US
Practice Address - Phone:718-224-8200
Practice Address - Fax:718-819-0244
Is Sole Proprietor?:No
Enumeration Date:2012-11-17
Last Update Date:2012-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY014810363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant