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NPI Code Detail

MEDICARE: AVENUE TO WELLNESS LLC

MEDICARE: AVENUE TO WELLNESS LLC
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
1133V00000XRegistered Dietitian
2207RB0002XObesity Medicine (Internal Medicine) Physician
3363AM0700XMedical Physician Assistant
4207RA0401XAddiction Medicine (Internal Medicine) PhysicianMD-053097-LPA
5208VP0000XPain Medicine PhysicianMD-053097-LPA
6363LP2300XPrimary Care Nurse Practitioner
7207R00000XInternal Medicine Physician

General Provider Information

NPI Number : 1700171022
Entity Type Code : Organization
Provider Name (Legal Business Name) : AVENUE TO WELLNESS LLC
Provider Business Mailing Address
First Line : 420 S DALLAS AVE
Second Line :
City : PITTSBURGH
State : PA
Zip : 15208-2819
Country : US
Telephone Number : 412-362-9797
Fax Number :
Provider Business Practice Location Address
First Line : 330 E 8TH AVE
Second Line :
City : HOMESTEAD
State : PA
Zip : 15120-1518
Country : US
Telephone Number : 412-462-6001
Fax Number :
Authorized Official
Title or Position : MEDICAL DIRECTOR
Name : VERA SHERMAN
Credential : M.D.
Telephone Number : 412-462-6001
Provider Enumeration Date : 06/15/2011
Last Update Date : 02/07/2016

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Directions to “AVENUE TO WELLNESS LLC ” Practice Location

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