Healthcare Provider Details

I. General information

NPI: 1548229776
Provider Name (Legal Business Name): DEBORAH SCANNELL I RPA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/17/2006
Last Update Date: 11/22/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 WESTAGE BUSINESS CTR DR
FISHKILL NY
12524-2281
US

IV. Provider business mailing address

110 S BEDFORD RD CAREMOUNT MEDICAL PC
MOUNT KISCO NY
10549-3446
US

V. Phone/Fax

Practice location:
  • Phone: 845-231-5600
  • Fax: 845-231-5489
Mailing address:
  • Phone: 914-241-1050
  • Fax: 914-242-1516

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number004069
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: