MEDICARE: NVELUP TELEHEALTH PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084P0800X	Psychiatry Physician

General Provider Information

NPI Number	:	1356952766
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NVELUP TELEHEALTH PLLC

Provider Business Mailing Address
First Line	:	PO BOX 7221
Second Line	:
City	:	PETALUMA
State	:	CA
Zip	:	94955-7221
Country	:	US
Telephone Number	:	509-242-9202
Fax Number	:	360-991-0265

Provider Business Practice Location Address
First Line	:	1455 NORTHWEST LEARY WAY
Second Line	:	SUITE 400-#101
City	:	SEATTLE
State	:	WA
Zip	:	98107-9810
Country	:	US
Telephone Number	:	509-242-9202
Fax Number	:	360-991-0265

Authorized Official
Title or Position	:	COO
Name	:	TROY DI LELLO
Credential	:
Telephone Number	:	509-242-9202

Provider Enumeration Date	:	08/11/2020
Last Update Date	:	07/16/2025

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Directions to “NVELUP TELEHEALTH PLLC ” Practice Location

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