Provider Demographics
NPI:1871113605
Name:AMARILLO, JAIRO MATTHEW (PA-S)
Entity type:Individual
Prefix:
First Name:JAIRO
Middle Name:MATTHEW
Last Name:AMARILLO
Suffix:
Gender:M
Credentials:PA-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:203 SYCAMORE ST UNIT 2
Mailing Address - Street 2:
Mailing Address - City:WATERTOWN
Mailing Address - State:MA
Mailing Address - Zip Code:02472-1058
Mailing Address - Country:US
Mailing Address - Phone:908-642-0176
Mailing Address - Fax:
Practice Address - Street 1:203 SYCAMORE ST UNIT 2
Practice Address - Street 2:
Practice Address - City:WATERTOWN
Practice Address - State:MA
Practice Address - Zip Code:02472-1058
Practice Address - Country:US
Practice Address - Phone:908-642-0176
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-22
Last Update Date:2024-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH2811363A00000X
MAPA79252086X0206X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086X0206XAllopathic & Osteopathic PhysiciansSurgerySurgical Oncology
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant