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General NPI Number Information
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NPI Number | 1255376711
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Entity Type | Individual
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Provider Name | LARISSA ZAULYANOV SCANLAN MD
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Gender | Female
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Dates
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Enumeration Date | 06/18/2006
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Last Update Date | 06/03/2015
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Provider Practice Location Address
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Address Line | 13550 JOG ROAD S. D201
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City | DELRAY BEACH
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State | FL
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Zip | 33446-3809
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Country | US
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Telephone | 561-637-2516
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Fax | 561-637-4657
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Provider Business Mailing Address
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Address Line | 13550 JOG ROAD S. D201
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City | DELRAY BEACH
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State | FL
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Zip | 33446-3809
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Country | US
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Telephone | 561-637-2516
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Fax | 561-637-4657
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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 | 207ND0101X
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Taxonomy Name | MOHS-Micrographic Surgery Physician
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License Number | ME95300
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License Number State | FL
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