Provider Demographics
NPI:1730893827
Name:DEMAIOLO, GINA
Entity type:Individual
Prefix:
First Name:GINA
Middle Name:
Last Name:DEMAIOLO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 SHENANGO AVE
Mailing Address - Street 2:
Mailing Address - City:SHARON
Mailing Address - State:PA
Mailing Address - Zip Code:16146-1503
Mailing Address - Country:US
Mailing Address - Phone:724-770-9095
Mailing Address - Fax:724-770-9096
Practice Address - Street 1:176 VIRGINIA AVE
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:PA
Practice Address - Zip Code:15074-1723
Practice Address - Country:US
Practice Address - Phone:724-770-9095
Practice Address - Fax:724-770-9096
Is Sole Proprietor?:No
Enumeration Date:2023-01-12
Last Update Date:2023-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN639623163W00000X
PASP026715363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse