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Individual
MRS. KERIANN MICHELLE SCAVONE
Active
Individual
MRS. KERIANN MICHELLE SCAVONE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
P.A.-C
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
015742
NY
363A00000X
Physician Assistant
25MP00373300
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0157421
PHYSICIAN ASSISTANT LICENSE
NY
01
—
25MP00373300
PHYSICIAN ASSISTANT LICENSE
NJ
01
—
A00379400
NJ CDS LICENSE
—
Enumeration date
07/25/2012
Last updated
03/07/2023
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