# MRS. KERIANN MICHELLE SCAVONE

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- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** No

## Provider details

- **NPI number:** 1588910772
- **Gender:** F
- **Credential:** P.A.-C

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 363A00000X | Physician Assistant | 015742 | NY | Yes |
| 363A00000X | Physician Assistant | 25MP00373300 | NJ | — |

## Other

- **Enumeration date:** 07/25/2012
- **Last updated:** 03/07/2023

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 0157421 | PHYSICIAN ASSISTANT LICENSE | NY |
| 01 | — | 25MP00373300 | PHYSICIAN ASSISTANT LICENSE | NJ |
| 01 | — | A00379400 | NJ CDS LICENSE | — |