Healthcare Provider Details

I. General information

NPI: 1659646834
Provider Name (Legal Business Name): SCOTT MICHAEL WASILKO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/20/2012
Last Update Date: 04/24/2026
Certification Date: 04/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2190 HIGHWAY 85 N
NICEVILLE FL
32578-1045
US

IV. Provider business mailing address

2190 HIGHWAY 85 N
NICEVILLE FL
32578-1045
US

V. Phone/Fax

Practice location:
  • Phone: 814-577-5482
  • Fax:
Mailing address:
  • Phone: 814-577-5482
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number042.0017023
License Number StateVT
# 2
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberME134637
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: