Healthcare Provider Details

I. General information

NPI: 1861556409
Provider Name (Legal Business Name): JANE ELLEN VALVODA MS. RD. LD. CDE.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/20/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13207 RAVENNA RD NUTRITION SERVICES DEPARTMENT
CHARDON OH
44024-7032
US

IV. Provider business mailing address

13207 RAVENNA RD UH GEAUGA MEDICAL CENTER
CHARDON OH
44024-7032
US

V. Phone/Fax

Practice location:
  • Phone: 440-285-6156
  • Fax:
Mailing address:
  • Phone: 440-285-6156
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberLD 488
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: