Healthcare Provider Details

I. General information

NPI: 1003326976
Provider Name (Legal Business Name): ANTONIO SCASSA BSN RN MSN CNP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/05/2017
Last Update Date: 08/23/2022
Certification Date: 08/23/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

125 CANTON RD NW STE A
CARROLLTON OH
44615-1009
US

IV. Provider business mailing address

1330 MERCY DR NW STE 506
CANTON OH
44708-2625
US

V. Phone/Fax

Practice location:
  • Phone: 330-627-8163
  • Fax:
Mailing address:
  • Phone: 330-588-4575
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN.CNP.021890
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number381666
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: