Provider Demographics
NPI:1972748168
Name:SHARIFI-AZAD, JESSICA (RPA-C)
Entity type:Individual
Prefix:MS
First Name:JESSICA
Middle Name:
Last Name:SHARIFI-AZAD
Suffix:
Gender:
Credentials:RPA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:525 ROUTE 73 N STE 117
Mailing Address - Street 2:
Mailing Address - City:MARLTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08053-3422
Mailing Address - Country:US
Mailing Address - Phone:888-803-3370
Mailing Address - Fax:
Practice Address - Street 1:525 ROUTE 73 N STE 117
Practice Address - Street 2:
Practice Address - City:MARLTON
Practice Address - State:NJ
Practice Address - Zip Code:08053-3422
Practice Address - Country:US
Practice Address - Phone:888-803-3370
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-12-03
Last Update Date:2025-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA056645363AM0700X
NJ25MP00527200363AM0700X
NYMS1705384363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical