Healthcare Provider Details

I. General information

NPI: 1649220583
Provider Name (Legal Business Name): SCOTT S. CALLEN CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/11/2006
Last Update Date: 12/03/2025
Certification Date: 12/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

85 HERRICK ST
BEVERLY MA
01915-1790
US

IV. Provider business mailing address

PROVIDER ENROLLMENT 41 MALL ROAD
BURLINGTON MA
01805-0001
US

V. Phone/Fax

Practice location:
  • Phone: 978-816-3700
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberRN10000289
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number4006657
License Number StateKY
# 3
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number0024188439
License Number StateVA
# 4
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number484280
License Number StateNY
# 5
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberARNP3253332
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: