Healthcare Provider Details

I. General information

NPI: 1932915717
Provider Name (Legal Business Name): ANTHONY SCOCCOLO PHYSICIAN ASSISTANT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/06/2024
Last Update Date: 06/29/2026
Certification Date: 06/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

98 E LAKE MEAD PKWY STE 105
HENDERSON NV
89015-6443
US

IV. Provider business mailing address

1785 E SAHARA AVE STE 340
LAS VEGAS NV
89104-3717
US

V. Phone/Fax

Practice location:
  • Phone: 702-823-4300
  • Fax:
Mailing address:
  • Phone: 702-823-4300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA3437
License Number StateNV
# 2
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA3437
License Number StateNV
# 3
Primary TaxonomyN
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License NumberPA3437
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: