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General NPI Number Information
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NPI Number | 1194717199
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Entity Type | Individual
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Provider Name | LORI J DAVELLO MD
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Gender | Female
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Dates
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Enumeration Date | 08/17/2005
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Last Update Date | 12/03/2020
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Provider Practice Location Address
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Address Line | 3800 EMBASSY PKWY STE 260
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City | FAIRLAWN
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State | OH
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Zip | 44333-8398
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Country | US
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Telephone | 330-664-8120
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Fax | 330-664-8121
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Provider Business Mailing Address
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Address Line | 3800 EMBASSY PKWY STE 260
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City | FAIRLAWN
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State | OH
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Zip | 44333-8398
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Country | US
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Telephone | 330-664-8120
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Fax | 330-664-8121
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 35-05-7622
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License Number State | OH
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