Provider Demographics
NPI:1588800429
Name:AVALLONE, JENNIFER MARY (DO)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:MARY
Last Name:AVALLONE
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:550 S GODDARD BLVD
Mailing Address - Street 2:
Mailing Address - City:KING OF PRUSSIA
Mailing Address - State:PA
Mailing Address - Zip Code:19406-2922
Mailing Address - Country:US
Mailing Address - Phone:215-590-1719
Mailing Address - Fax:
Practice Address - Street 1:550 S GODDARD BLVD
Practice Address - Street 2:
Practice Address - City:KING OF PRUSSIA
Practice Address - State:PA
Practice Address - Zip Code:19406-2922
Practice Address - Country:US
Practice Address - Phone:215-590-1719
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-24
Last Update Date:2022-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS0217292084N0402X, 2084N0600X
FLOS144962084N0402X, 2084N0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0600XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyClinical NeurophysiologyGroup - Single Specialty
No2084N0402XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology with Special Qualifications in Child Neurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLOS14496OtherSTATE OF FLORIDA DEPT OF HEALTH