Provider Demographics
NPI:1497281786
Name:GOLDWASSER, AVITAL S (NP)
Entity Type:Individual
Prefix:
First Name:AVITAL
Middle Name:S
Last Name:GOLDWASSER
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:AVITAL
Other - Middle Name:S
Other - Last Name:SLYPER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2619 TILBURY AVE
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15217-2514
Mailing Address - Country:US
Mailing Address - Phone:301-254-4912
Mailing Address - Fax:
Practice Address - Street 1:2619 TILBURY AVE
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15217-2514
Practice Address - Country:US
Practice Address - Phone:301-254-4912
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-04
Last Update Date:2017-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP017318363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health