Healthcare Provider Details

I. General information

NPI: 1811529217
Provider Name (Legal Business Name): JULIA MARIA DONATELLI PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/04/2020
Last Update Date: 11/05/2023
Certification Date: 11/05/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1265 WAYNE AVE STE 306
INDIANA PA
15701-3501
US

IV. Provider business mailing address

640 KOLTER DR
INDIANA PA
15701-3570
US

V. Phone/Fax

Practice location:
  • Phone: 724-463-9701
  • Fax: 724-463-9701
Mailing address:
  • Phone: 724-357-7333
  • Fax: 724-357-7279

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberMA061073
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: