MEDICARE: ROBERT SCALISE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103K00000X	Behavior Analyst	LBA0148	NV

General Provider Information

NPI Number	:	1255887543
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROBERT SCALISE

Provider Business Mailing Address
First Line	:	635 REGAL ROBIN WAY
Second Line	:
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89084-1236
Country	:	US
Telephone Number	:	702-670-2261
Fax Number	:

Provider Business Practice Location Address
First Line	:	635 REGAL ROBIN WAY
Second Line	:
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89084-1236
Country	:	US
Telephone Number	:	702-670-2261
Fax Number	:	702-819-7738

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/28/2016
Last Update Date	:	12/02/2025

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