Healthcare Provider Details

I. General information

NPI: 1184948077
Provider Name (Legal Business Name): DAPHNE AMANDA SCOTT MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/21/2010
Last Update Date: 04/20/2021
Certification Date: 04/20/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

535 E 70TH ST
NEW YORK NY
10021-4823
US

IV. Provider business mailing address

535 E 70TH ST
NEW YORK NY
10021-4823
US

V. Phone/Fax

Practice location:
  • Phone: 212-774-7070
  • Fax: 212-774-2009
Mailing address:
  • Phone: 212-774-7070
  • Fax: 212-774-2009

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License Number2802661
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License Number54254
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: