Provider Demographics
NPI:1831253517
Name:SIEVERING, JEFFREY TAYLOR (PA-C, MMS)
Entity type:Individual
Prefix:MR
First Name:JEFFREY
Middle Name:TAYLOR
Last Name:SIEVERING
Suffix:
Gender:M
Credentials:PA-C, MMS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 SOMERS HILL CIR
Mailing Address - Street 2:
Mailing Address - City:SOMERS
Mailing Address - State:CT
Mailing Address - Zip Code:06071-1928
Mailing Address - Country:US
Mailing Address - Phone:860-763-0349
Mailing Address - Fax:860-282-4636
Practice Address - Street 1:25 SOMERS HILL CIR
Practice Address - Street 2:
Practice Address - City:SOMERS
Practice Address - State:CT
Practice Address - Zip Code:06071-1928
Practice Address - Country:US
Practice Address - Phone:860-763-0349
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-20
Last Update Date:2023-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT1377363AM0700X, 363A00000X
TXPA02128363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical