Provider Demographics
NPI:1194906792
Name:PAVLATOS-DELAVOYE, NICOLE S (MD)
Entity type:Individual
Prefix:DR
First Name:NICOLE
Middle Name:S
Last Name:PAVLATOS-DELAVOYE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:NICOLE
Other - Middle Name:S
Other - Last Name:PAVLATOS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:770 TRADEMARK DR
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89521-5926
Mailing Address - Country:US
Mailing Address - Phone:775-813-4288
Mailing Address - Fax:
Practice Address - Street 1:770 TRADEMARK DR
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89521-5926
Practice Address - Country:US
Practice Address - Phone:775-813-4288
Practice Address - Fax:775-982-4196
Is Sole Proprietor?:No
Enumeration Date:2007-11-25
Last Update Date:2021-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV148562084P0800X
IN01072103A2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1194906792Medicaid