Healthcare Provider Details

I. General information

NPI: 1275203770
Provider Name (Legal Business Name): JORDAN ALYSSA DABECCO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/15/2021
Last Update Date: 09/09/2025
Certification Date: 09/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

429 4TH AVE FL 7
PITTSBURGH PA
15219-1500
US

IV. Provider business mailing address

429 4TH AVE FL 7
PITTSBURGH PA
15219-1500
US

V. Phone/Fax

Practice location:
  • Phone: 888-731-8994
  • Fax:
Mailing address:
  • Phone: 888-731-8994
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberSP024244
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: