Provider Demographics
NPI:1487989703
Name:LAVELAH, JATU YAMALOUPO (GNP)
Entity type:Individual
Prefix:MRS
First Name:JATU
Middle Name:YAMALOUPO
Last Name:LAVELAH
Suffix:
Gender:F
Credentials:GNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:42 PELTON AVE
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10310-1517
Mailing Address - Country:US
Mailing Address - Phone:718-556-3584
Mailing Address - Fax:718-556-3584
Practice Address - Street 1:42 PELTON AVE
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10310-1517
Practice Address - Country:US
Practice Address - Phone:718-556-3584
Practice Address - Fax:718-556-3584
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-04
Last Update Date:2009-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF-340752163WG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WG0600XNursing Service ProvidersRegistered NurseGerontology