Provider Demographics
NPI:1780301531
Name:DEMARAY, JILLIAN LEE (CPNP-PC)
Entity type:Individual
Prefix:
First Name:JILLIAN
Middle Name:LEE
Last Name:DEMARAY
Suffix:
Gender:F
Credentials:CPNP-PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27 DANNY RD
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02136-1908
Mailing Address - Country:US
Mailing Address - Phone:617-895-8211
Mailing Address - Fax:
Practice Address - Street 1:541 HIGH ST
Practice Address - Street 2:
Practice Address - City:WESTWOOD
Practice Address - State:MA
Practice Address - Zip Code:02090-1628
Practice Address - Country:US
Practice Address - Phone:781-326-7700
Practice Address - Fax:781-251-0910
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-24
Last Update Date:2024-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2344675363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics