Provider Demographics
NPI:1366715724
Name:SAETTA, JILLIAN EILEEN (PA)
Entity type:Individual
Prefix:
First Name:JILLIAN
Middle Name:EILEEN
Last Name:SAETTA
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:JILLIAN
Other - Middle Name:EILEEN
Other - Last Name:HUNTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:21 EASTPORT MANOR RD STE 2
Mailing Address - Street 2:
Mailing Address - City:EASTPORT
Mailing Address - State:NY
Mailing Address - Zip Code:11941-1410
Mailing Address - Country:US
Mailing Address - Phone:631-325-2255
Mailing Address - Fax:631-325-8562
Practice Address - Street 1:21 EASTPORT MANOR RD
Practice Address - Street 2:
Practice Address - City:EASTPORT
Practice Address - State:NY
Practice Address - Zip Code:11941-1410
Practice Address - Country:US
Practice Address - Phone:631-025-2255
Practice Address - Fax:631-325-8562
Is Sole Proprietor?:No
Enumeration Date:2012-02-15
Last Update Date:2025-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY019694363AM0700X
AZ5893363A00000X, 363AS0400X
NY0196942363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant