Provider Demographics
NPI:1306881669
Name:NOWILLO, JESSICA SOLANDA (DO)
Entity type:Individual
Prefix:DR
First Name:JESSICA
Middle Name:SOLANDA
Last Name:NOWILLO
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Gender:F
Credentials:DO
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Mailing Address - Street 1:PO BOX 567
Mailing Address - Street 2:
Mailing Address - City:CROSS RIVER
Mailing Address - State:NY
Mailing Address - Zip Code:10518-0567
Mailing Address - Country:US
Mailing Address - Phone:914-334-6127
Mailing Address - Fax:914-287-2682
Practice Address - Street 1:35-37 PURCHASE ST STE 203
Practice Address - Street 2:
Practice Address - City:RYE
Practice Address - State:NY
Practice Address - Zip Code:10580-3056
Practice Address - Country:US
Practice Address - Phone:914-334-6127
Practice Address - Fax:914-306-8704
Is Sole Proprietor?:No
Enumeration Date:2006-06-19
Last Update Date:2024-03-15
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Provider Licenses
StateLicense IDTaxonomies
NY236008-12084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY155865Medicare UPIN