Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

MS. Jessica Lorraine Wallace, PA

Individual provider Medical Physician Assistant · NPI 1588407720

MS. Jessica Lorraine Wallace, PA is a Medical Physician Assistant in Staten Island, New York. Licensed in New York. Registered with an NPI since 2024.

Licensed in
NY
In the registry since
2024
Specialties on file
2
What do these letters mean?
PA — Physician Assistant
A licensed clinician who examines, diagnoses and treats under a physician's supervision.

See every abbreviation used in this directory →

Practice location Address checks out

355 Bard Ave
Staten Island, NY 10310-1664
Phone: (718) 818-2995
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Medical Physician Assistant (primary) Taxonomy 363AM0700X · Licence 032571 (NY)
Medical Physician Assistant Taxonomy 363AM0700X (NY)

Record details

NPI number1588407720
Entity typeIndividual (Type 1)
GenderFemale
Credentials PA
Sole proprietorNo
NPI enumeratedJune 17, 2024
Last updated in NPPESAugust 14, 2025
Certification dateAugust 14, 2025

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