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General NPI Number Information
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NPI Number | 1700171022
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Entity Type | Organization
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Legal Business Name | AVENUE TO WELLNESS LLC
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Dates
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Enumeration Date | 06/15/2011
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Last Update Date | 02/07/2016
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Provider Practice Location Address
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Address Line | 330 E 8TH AVE
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City | HOMESTEAD
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State | PA
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Zip | 15120-1518
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Country | US
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Telephone | 412-462-6001
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Fax |
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Provider Business Mailing Address
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Address Line | 420 S DALLAS AVE
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City | PITTSBURGH
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State | PA
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Zip | 15208-2819
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Country | US
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Telephone | 412-362-9797
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Fax |
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | VERA SHERMAN
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Credential | M.D.
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Telephone | 412-462-6001
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 133V00000X
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Taxonomy Name | Registered Dietitian
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207RB0002X
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Taxonomy Name | Obesity Medicine (Internal Medicine) Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 207RA0401X
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Taxonomy Name | Addiction Medicine (Internal Medicine) Physician
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License Number | MD-053097-L
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License Number State | PA
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Taxonomy #5
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Taxonomy Code | 208VP0000X
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Taxonomy Name | Pain Medicine Physician
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License Number | MD-053097-L
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License Number State | PA
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Taxonomy #6
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Taxonomy Code | 363LP2300X
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Taxonomy Name | Primary Care Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #7
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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