Healthcare Provider Details

I. General information

NPI: 1912081530
Provider Name (Legal Business Name): ANGELIQUE C SCICCHITANO PAC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/24/2006
Last Update Date: 04/29/2026
Certification Date: 04/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3100 SCHOOLHOUSE RD STE 100
MIDDLETOWN PA
17057-3548
US

IV. Provider business mailing address

3100 SCHOOLHOUSE RD STE 100
MIDDLETOWN PA
17057-3548
US

V. Phone/Fax

Practice location:
  • Phone: 717-531-7260
  • Fax: 717-531-0806
Mailing address:
  • Phone: 717-531-7260
  • Fax: 717-531-0806

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberMA002313L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: