Healthcare Provider Details

I. General information

NPI: 1700804846
Provider Name (Legal Business Name): SCOTT A SACHATELLO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/17/2006
Last Update Date: 03/11/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1250 S 18TH ST
FERNANDINA BEACH FL
32034-1902
US

IV. Provider business mailing address

820 PRUDENTIAL DR STE 713
JACKSONVILLE FL
32207-8209
US

V. Phone/Fax

Practice location:
  • Phone: 904-396-5682
  • Fax: 904-346-0864
Mailing address:
  • Phone: 904-396-5682
  • Fax: 904-346-0864

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberME84671
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: