Provider Demographics
NPI:1457635229
Name:LAVELLE, SANDRA WOLFE (NP)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:WOLFE
Last Name:LAVELLE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:DR
Other - First Name:SANDRA
Other - Middle Name:WOLFE
Other - Last Name:LAVELLE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:NP
Mailing Address - Street 1:7316 GLENSIDE LN
Mailing Address - Street 2:
Mailing Address - City:OLMSTED FALLS
Mailing Address - State:OH
Mailing Address - Zip Code:44138-3121
Mailing Address - Country:US
Mailing Address - Phone:440-382-7211
Mailing Address - Fax:
Practice Address - Street 1:23625 COMMERCE PARK STE 180
Practice Address - Street 2:
Practice Address - City:BEACHWOOD
Practice Address - State:OH
Practice Address - Zip Code:44122-5847
Practice Address - Country:US
Practice Address - Phone:440-382-7211
Practice Address - Fax:216-342-1110
Is Sole Proprietor?:No
Enumeration Date:2011-09-28
Last Update Date:2020-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCOA12811-NP363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health