Healthcare Provider Details

I. General information

NPI: 1083039309
Provider Name (Legal Business Name): JAMIE DELVECCHIO DO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/24/2014
Last Update Date: 11/02/2023
Certification Date: 11/02/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 7TH AVE STE 200
CHARDON OH
44024-2909
US

IV. Provider business mailing address

6480 HARRISON AVE STE 201
CINCINNATI OH
45247-7961
US

V. Phone/Fax

Practice location:
  • Phone: 440-285-4999
  • Fax: 440-285-5870
Mailing address:
  • Phone: 440-285-4999
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License Number34.012938
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: