Provider Demographics
NPI:1407661762
Name:STAVAR, JESSICA KAYLA (PA-C)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:KAYLA
Last Name:STAVAR
Suffix:
Gender:F
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 1:3700 NJ-33 STE 101
Mailing Address - Street 2:
Mailing Address - City:NEPTUNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07753
Mailing Address - Country:US
Mailing Address - Phone:732-280-7855
Mailing Address - Fax:
Practice Address - Street 1:3700 NJ-33 STE 101
Practice Address - Street 2:
Practice Address - City:NEPTUNE TOWNSHIP
Practice Address - State:NJ
Practice Address - Zip Code:07753
Practice Address - Country:US
Practice Address - Phone:732-280-7855
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-12
Last Update Date:2025-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant