Provider Demographics
NPI:1215325147
Name:VELARDI, JESSICA (PA-C)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:VELARDI
Suffix:
Gender:
Credentials:PA-C
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:
Other - Last Name:MANGIARACINA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:235 BOSTON POST RD STE 201
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:CT
Mailing Address - Zip Code:06477-3229
Mailing Address - Country:US
Mailing Address - Phone:203-865-6143
Mailing Address - Fax:203-772-1265
Practice Address - Street 1:235 BOSTON POST RD STE 201
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:CT
Practice Address - Zip Code:06477-3229
Practice Address - Country:US
Practice Address - Phone:203-865-6143
Practice Address - Fax:203-772-1265
Is Sole Proprietor?:No
Enumeration Date:2014-12-30
Last Update Date:2025-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
363A00000X
NY018326363AM0700X
CT3528363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant