Provider Demographics
NPI:1366310856
Name:AVELLO, ISAAC NATHANAEL
Entity type:Individual
Prefix:
First Name:ISAAC
Middle Name:NATHANAEL
Last Name:AVELLO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1505 W THARPE ST APT 1534
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32303-4543
Mailing Address - Country:US
Mailing Address - Phone:850-345-7701
Mailing Address - Fax:
Practice Address - Street 1:1983 MAHAN DR STE C
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32308-6121
Practice Address - Country:US
Practice Address - Phone:850-345-7701
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-10-27
Last Update Date:2025-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician