MEDICARE: ANTHONY SCOCCOLO PHYSICIAN ASSISTANT

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	363AS0400X	Surgical Physician Assistant	PA3437	NV
2	363A00000X	Physician Assistant	PA3437	NV
3	363AM0700X	Medical Physician Assistant	PA3437	NV

General Provider Information

NPI Number	:	1932915717
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANTHONY SCOCCOLO PHYSICIAN ASSISTANT

Provider Business Mailing Address
First Line	:	1785 E SAHARA AVE STE 340
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89104-3717
Country	:	US
Telephone Number	:	702-823-4300
Fax Number	:

Provider Business Practice Location Address
First Line	:	98 E LAKE MEAD PKWY STE 105
Second Line	:
City	:	HENDERSON
State	:	NV
Zip	:	89015-6443
Country	:	US
Telephone Number	:	702-823-4300
Fax Number	:

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

Provider Enumeration Date	:	12/06/2024
Last Update Date	:	04/09/2026

Similar Medicare Providers

1033353032 — EMILY K PETERSON DO
Practice Location Address:

98 E LAKE MEAD PKWY STE 102
HENDERSON, NV
89015-6443

Practice Phone: 702-868-0327
Practice Fax: 702-868-0290

1922941970 — NOMAD WHOLE WELLNESS LLC
Practice Location Address:

98 E LAKE MEAD PKWY STE 105
HENDERSON, NV
89015-6443

Practice Phone: 253-376-4234
Practice Fax:

1760403455 — DR. KAMI A.K. LARSEN M.D.
Practice Location Address:

98 E LAKE MEAD PKWY STE 103
HENDERSON, NV
89015-6443

Practice Phone: 702-868-0327
Practice Fax: 702-868-0290

1942577994 — BAMBOO SUNRISE LLC
Practice Location Address:

98 E LAKE MEAD PKWY STE 201
HENDERSON, NV
89015-6443

Practice Phone: 702-433-3038
Practice Fax:

1699140921 — KRYSTAL GUTIERREZ-AVILA LCSW
Practice Location Address:

98 E LAKE MEAD PKWY STE 103
HENDERSON, NV
89015-6443

Practice Phone: 702-868-0327
Practice Fax: 702-868-0290

1245743509 — DESTINY BROADEN AUD
Practice Location Address:

98 E LAKE MEAD PKWY STE 105
HENDERSON, NV
89015-6443

Practice Phone: 702-861-1183
Practice Fax:

Directions to “ ANTHONY SCOCCOLO PHYSICIAN ASSISTANT” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.