Provider Demographics
NPI:1104140615
Name:TRAVALI, JANNETTE
Entity type:Individual
Prefix:
First Name:JANNETTE
Middle Name:
Last Name:TRAVALI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:JANNETTE
Other - Middle Name:
Other - Last Name:TRAVALI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MS, MPH, MS
Mailing Address - Street 1:215 CLIFFSIDE DR
Mailing Address - Street 2:
Mailing Address - City:MARS
Mailing Address - State:PA
Mailing Address - Zip Code:16046-4801
Mailing Address - Country:US
Mailing Address - Phone:724-779-9033
Mailing Address - Fax:
Practice Address - Street 1:100 NORTHPOINTE CIR
Practice Address - Street 2:SUITE 306
Practice Address - City:SEVEN FIELDS
Practice Address - State:PA
Practice Address - Zip Code:16046-7851
Practice Address - Country:US
Practice Address - Phone:724-779-9033
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-26
Last Update Date:2010-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X
PADN001605133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No133V00000XDietary & Nutritional Service ProvidersDietitian, Registered