Provider Demographics
NPI:1851180996
Name:ROSARIO, JUDELISSA (MS)
Entity type:Individual
Prefix:
First Name:JUDELISSA
Middle Name:
Last Name:ROSARIO
Suffix:
Gender:
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2615 LEXINGTON ST
Mailing Address - Street 2:
Mailing Address - City:HARRISBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17110-2626
Mailing Address - Country:US
Mailing Address - Phone:484-896-8558
Mailing Address - Fax:
Practice Address - Street 1:2615 LEXINGTON ST
Practice Address - Street 2:
Practice Address - City:HARRISBURG
Practice Address - State:PA
Practice Address - Zip Code:17110-2626
Practice Address - Country:US
Practice Address - Phone:484-896-8558
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-05
Last Update Date:2025-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA85563601251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health