Provider Demographics
NPI:1881620623
Name:DONNELLY, JEFFREY P (PA-C)
Entity type:Individual
Prefix:
First Name:JEFFREY
Middle Name:P
Last Name:DONNELLY
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 24863
Mailing Address - Street 2:
Mailing Address - City:CHRISTIANSTED
Mailing Address - State:VI
Mailing Address - Zip Code:00824-0863
Mailing Address - Country:US
Mailing Address - Phone:340-642-5460
Mailing Address - Fax:
Practice Address - Street 1:516 STRAND ST
Practice Address - Street 2:FREDERIKSTED HEALTH CENTER
Practice Address - City:FREDERIKSTED
Practice Address - State:VI
Practice Address - Zip Code:00840-3533
Practice Address - Country:US
Practice Address - Phone:340-772-0260
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-23
Last Update Date:2017-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VI060363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant