Individual
JENNA CHRISTINA DISTASIO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
91 PARKER HILL AVE, ROXBURY CROSSING, MA 02120-3215
(617) 754-6742
(617) 754-6443
Mailing address
20 GUEST ST, STE 225, BRIGHTON, MA 02135-2065
(617) 738-8642
(617) 202-4172
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
2229
MA
Other
Enumeration date
05/25/2007
Last updated
08/19/2020
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