Provider Demographics
NPI:1194556837
Name:AVITALLE, JAMES (HIS)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:
Last Name:AVITALLE
Suffix:
Gender:M
Credentials:HIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2205 SILVERSIDE RD STE 4
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19810-4534
Mailing Address - Country:US
Mailing Address - Phone:302-529-9103
Mailing Address - Fax:302-529-9104
Practice Address - Street 1:2205 SILVERSIDE RD STE 4
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19810-4534
Practice Address - Country:US
Practice Address - Phone:302-529-9103
Practice Address - Fax:302-529-9104
Is Sole Proprietor?:No
Enumeration Date:2024-08-13
Last Update Date:2024-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEO3-0010305237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist