Healthcare Provider Details

I. General information

NPI: 1477146371
Provider Name (Legal Business Name): DANA SCACCO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/11/2021
Last Update Date: 02/15/2021
Certification Date: 02/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

241 WOODBURY RD
HICKSVILLE NY
11801-3027
US

IV. Provider business mailing address

241 WOODBURY RD
HICKSVILLE NY
11801-3027
US

V. Phone/Fax

Practice location:
  • Phone: 631-332-7093
  • Fax:
Mailing address:
  • Phone: 631-332-7093
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: