MEDICARE: ANTHONY SCOCCOLO PHYSICIAN ASSISTANT

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	363AS0400X	Surgical Physician Assistant	PA3437	NV
2	363A00000X	Physician Assistant	PA3437	NV
3	363AM0700X	Medical Physician Assistant	PA3437	NV

General Provider Information

NPI Number	:	1932915717
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANTHONY SCOCCOLO PHYSICIAN ASSISTANT

Provider Business Mailing Address
First Line	:	1785 E SAHARA AVE STE 340
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89104-3717
Country	:	US
Telephone Number	:	702-823-4300
Fax Number	:

Provider Business Practice Location Address
First Line	:	98 E LAKE MEAD PKWY STE 105
Second Line	:
City	:	HENDERSON
State	:	NV
Zip	:	89015-6443
Country	:	US
Telephone Number	:	702-823-4300
Fax Number	:

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

Provider Enumeration Date	:	12/06/2024
Last Update Date	:	06/29/2026

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