Healthcare Provider Details

I. General information

NPI: 1710692579
Provider Name (Legal Business Name): DEVON ELENA BRODINE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/17/2023
Last Update Date: 06/16/2026
Certification Date: 06/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 BROOKS LN STE G20
JEFFERSON HILLS PA
15025-3752
US

IV. Provider business mailing address

2 ALLEGHENY CTR STE 560
PITTSBURGH PA
15212-5402
US

V. Phone/Fax

Practice location:
  • Phone: 412-267-5040
  • Fax: 412-384-3505
Mailing address:
  • Phone: 412-330-4461
  • Fax: 412-330-5844

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number50.007969
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberMA067652
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: