Provider Demographics
NPI:1427510734
Name:FEDELE, JACQUELYN
Entity type:Individual
Prefix:
First Name:JACQUELYN
Middle Name:
Last Name:FEDELE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 S MAIN STREET
Mailing Address - Street 2:2ND FLOOR SUITE A
Mailing Address - City:YARDLEY
Mailing Address - State:PA
Mailing Address - Zip Code:19067-1571
Mailing Address - Country:US
Mailing Address - Phone:215-493-4501
Mailing Address - Fax:215-493-4501
Practice Address - Street 1:7 S MAIN STREET
Practice Address - Street 2:2ND FLOOR SUITE A
Practice Address - City:YARDLEY
Practice Address - State:PA
Practice Address - Zip Code:19067-1571
Practice Address - Country:US
Practice Address - Phone:215-493-4501
Practice Address - Fax:215-493-4501
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-04
Last Update Date:2019-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1114362241Medicaid