| Doctor Name: | JESSICA LEIGH BURSELL |
| NPI Number: | 1073848495 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | PA-C |
| License Number: | 002316 |
| Business Practice Address: | 4 Corporate Dr Suite # 484 Shelton, CT - 064846211 |
| Business Phone Number: | 2039449898 |
| Business Fax Number: | |
| Mailing Address: | 15 Deerwood Rd, OXFORD |
| State: | CT |
| Postal Code: | 064783209 |
| Phone Number: | 2033056977 |
| Fax Number: | |
| NPI Enumeration Date: | 10/04/2009 |
| NPI Last Update Date: | 10/07/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363AM0700X |
| License Number: | 002316 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | CT |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Physician Assistant |
| Taxonomy Specialization: | Medical |
| Taxonomy Definition: | |