Healthcare Provider Details

I. General information

NPI: 1003107640
Provider Name (Legal Business Name): ROBERT SCORDATO JR. PA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/01/2011
Last Update Date: 01/29/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4300 ALTON RD SUITE 2070
MIAMI BEACH FL
33140-2948
US

IV. Provider business mailing address

90 SW 3RD ST APT 4102
MIAMI FL
33130-2995
US

V. Phone/Fax

Practice location:
  • Phone: 305-674-2609
  • Fax:
Mailing address:
  • Phone: 347-215-1493
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberPA9107253
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number9107253
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: