Provider Demographics
NPI:1063251270
Name:JAFFRI, ALENA FATIMA (PA)
Entity type:Individual
Prefix:MS
First Name:ALENA
Middle Name:FATIMA
Last Name:JAFFRI
Suffix:
Gender:
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:165 THORNDIKE ST FL 4
Mailing Address - Street 2:
Mailing Address - City:LOWELL
Mailing Address - State:MA
Mailing Address - Zip Code:01852-3485
Mailing Address - Country:US
Mailing Address - Phone:978-955-9500
Mailing Address - Fax:
Practice Address - Street 1:165 THORNDIKE ST FL 4
Practice Address - Street 2:
Practice Address - City:LOWELL
Practice Address - State:MA
Practice Address - Zip Code:01852-3485
Practice Address - Country:US
Practice Address - Phone:978-955-9500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-20
Last Update Date:2025-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPA101377363A00000X
NY390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program