Healthcare Provider Details

I. General information

NPI: 1700171022
Provider Name (Legal Business Name): AVENUE TO WELLNESS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/15/2011
Last Update Date: 02/07/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

330 E 8TH AVE
HOMESTEAD PA
15120-1518
US

IV. Provider business mailing address

420 S DALLAS AVE
PITTSBURGH PA
15208-2819
US

V. Phone/Fax

Practice location:
  • Phone: 412-462-6001
  • Fax:
Mailing address:
  • Phone: 412-362-9797
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207RB0002X
TaxonomyObesity Medicine (Internal Medicine) Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code207RA0401X
TaxonomyAddiction Medicine (Internal Medicine) Physician
License NumberMD-053097-L
License Number StatePA
# 5
Primary TaxonomyN
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License NumberMD-053097-L
License Number StatePA
# 6
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number
License Number State
# 7
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: VERA SHERMAN
Title or Position: MEDICAL DIRECTOR
Credential: M.D.
Phone: 412-462-6001