Healthcare Provider Details

I. General information

NPI: 1255266029
Provider Name (Legal Business Name): VASSAR INTEGRATIVE PSYCHIATRY PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/15/2026
Last Update Date: 06/15/2026
Certification Date: 06/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

330 INNOVATION BLVD STE 205
STATE COLLEGE PA
16803-6611
US

IV. Provider business mailing address

274 FARNSLEIGH AVE
BLUFFTON SC
29910-7954
US

V. Phone/Fax

Practice location:
  • Phone: 912-250-5266
  • Fax: 888-855-8190
Mailing address:
  • Phone: 912-250-5266
  • Fax: 888-855-8190

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: KATRINA DENISE SCANNELLI
Title or Position: PHYSICIAN ASSISTANT-CONTR/EMPLOYEE
Credential: PA
Phone: 912-429-3749