MEDICARE: KATRINA DENISE SCANNELLI PA-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363AM0700X	Medical Physician Assistant	3469	GA
2	363A00000X	Physician Assistant
3	363A00000X	Physician Assistant	MA064316	PA
4	363AS0400X	Surgical Physician Assistant	PA3712	MA

General Provider Information

NPI Number	:	1912981143
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATRINA DENISE SCANNELLI PA-C

Provider Business Mailing Address
First Line	:	1915 E VICTORY DRIVE
Second Line	:	SUITE E #1059
City	:	SAVANNAH
State	:	GA
Zip	:	31404
Country	:	US
Telephone Number	:	912-429-3749
Fax Number	:

Provider Business Practice Location Address
First Line	:	42 CHAUCER ST
Second Line	:
City	:	SAVANNAH
State	:	GA
Zip	:	31410-3824
Country	:	US
Telephone Number	:	912-429-3749
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/01/2005
Last Update Date	:	03/07/2024

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