| Doctor Name: | JESSICA FEDORKA |
| NPI Number: | 1982043188 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | PA |
| License Number: | PA4674 |
| Business Practice Address: | 230 Washington St South Attleboro, MA - 027035518 |
| Business Phone Number: | 5087615650 |
| Business Fax Number: | 5087619870 |
| Mailing Address: | 230 Washington St, SOUTH ATTLEBORO |
| State: | MA |
| Postal Code: | 027035518 |
| Phone Number: | 5087615650 |
| Fax Number: | 5087619870 |
| NPI Enumeration Date: | 06/20/2013 |
| NPI Last Update Date: | 06/20/2013 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363AM0700X |
| License Number: | PA4674 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MA |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Physician Assistant |
| Taxonomy Specialization: | Medical |
| Taxonomy Definition: | |