Healthcare Provider Details

I. General information

NPI: 1568459592
Provider Name (Legal Business Name): SCOTT A NADENIK D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/04/2005
Last Update Date: 08/10/2020
Certification Date: 08/10/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2120 SW 22ND PL
OCALA FL
34471-7765
US

IV. Provider business mailing address

2120 SW 22ND PL
OCALA FL
34471-7765
US

V. Phone/Fax

Practice location:
  • Phone: 352-732-5042
  • Fax: 352-732-6031
Mailing address:
  • Phone: 352-732-5042
  • Fax: 352-732-6031

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207YX0905X
TaxonomyOtolaryngology/Facial Plastic Surgery Physician
License NumberOS0007636
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: