Healthcare Provider Details

I. General information

NPI: 1881247088
Provider Name (Legal Business Name): HILARY REVIELLO PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/17/2019
Last Update Date: 02/07/2025
Certification Date: 02/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1530 8TH AVE
BETHLEHEM PA
18018-1883
US

IV. Provider business mailing address

4188 EISENHOWER DR
BETHLEHEM PA
18020-8946
US

V. Phone/Fax

Practice location:
  • Phone: 484-526-6545
  • Fax:
Mailing address:
  • Phone: 610-554-5884
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberMA060751
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA9114408
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: