Stevan Eric Waleff, ATC, RN-BSN

Primary specialty

Athletic TrainerTaxonomy code 2255A2300X

License

RT001078A Issued in PA

Practice address

531 Reynolds Rd
Greenville, PA 16125-8889

Phone

(724) 646-5719

NPI assigned

Jan 7, 2020

Last updated

Jan 7, 2020By the provider in NPPES

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1578355200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1578355200000",
    "number": "1407496524",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "531 REYNOLDS ROAD",
            "city": "GREENVILLE",
            "state": "PA",
            "postal_code": "16125",
            "telephone_number": "724-646-5719"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "531 REYNOLDS RD",
            "city": "GREENVILLE",
            "state": "PA",
            "postal_code": "161258889",
            "telephone_number": "724-646-5719"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALEFF",
        "first_name": "STEVAN",
        "middle_name": "ERIC",
        "credential": "ATC, RN-BSN",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2020-01-07",
        "last_updated": "2020-01-07",
        "certification_date": "2020-01-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "PA",
            "license": "RN509797L",
            "primary": false
        },
        {
            "code": "2255A2300X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Athletic Trainer",
            "state": "PA",
            "license": "RT001078A",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Athletic Trainer in Greenville, PA
• Providers in Greenville, PA by specialty
• Athletic Trainer in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 7, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.