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General NPI Number Information
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NPI Number | 1093091076
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Entity Type | Individual
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Provider Name | MRS. KRISTIN ELIZABETH SCAVUZZO
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Gender | Female
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Dates
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Enumeration Date | 10/23/2011
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Last Update Date | 10/23/2011
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Provider Practice Location Address
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Address Line | 83 SUMMERFIELD DR
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City | HOLTSVILLE
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State | NY
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Zip | 11742-2500
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Country | US
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Telephone | 631-294-4950
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Fax |
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Provider Business Mailing Address
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Address Line | 83 SUMMERFIELD DR
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City | HOLTSVILLE
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State | NY
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Zip | 11742-2500
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Country | US
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Telephone | 631-294-4950
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 374700000X
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Taxonomy Name | Technician
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License Number | 1211-7744
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 376K00000X
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Taxonomy Name | Nurse's Aide
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License Number | 342903691209E
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License Number State | NY
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