Healthcare Provider Details

I. General information

NPI: 1538322714
Provider Name (Legal Business Name): LAURA ZAVADIL RD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/08/2008
Last Update Date: 12/21/2020
Certification Date: 12/21/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9820 ABBINGTON DR
CANFIELD OH
44406-7119
US

IV. Provider business mailing address

9820 ABBINGTON DR
CANFIELD OH
44406-7119
US

V. Phone/Fax

Practice location:
  • Phone: 330-559-1659
  • Fax:
Mailing address:
  • Phone: 330-559-1659
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133N00000X
TaxonomyNutritionist
License NumberDN003848
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberDN003848
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: