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General NPI Number Information
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NPI Number | 1902385255
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Entity Type | Organization
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Legal Business Name | SCIAMANDA TOTAL HEALTH AND WELLNESS
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Dates
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Enumeration Date | 08/08/2018
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Last Update Date | 11/04/2021
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Provider Practice Location Address
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Address Line | 1920 W 8TH ST
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City | ERIE
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State | PA
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Zip | 16505-4935
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Country | US
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Telephone | 814-456-1097
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Fax | 814-287-9375
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Provider Business Mailing Address
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Address Line | 1920 W 8TH ST
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City | ERIE
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State | PA
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Zip | 16505-4935
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Country | US
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Telephone | 814-456-1097
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Fax | 814-287-9375
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Authorized Official
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Title or Position | OWNER
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Name | DR. DOMINIC MARIANO SCIAMANDA
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Credential | DO
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Telephone | 814-456-1097
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | OS018175
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License Number State | PA
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