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Individual

MRS. KERIANN MICHELLE SCAVONE

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
P.A.-C

Contact information

Practice address
195 LITTLE ALBANY ST, NEW BRUNSWICK, NJ 08901-1914
(732) 235-4023
(732) 235-3299
Mailing address
195 LITTLE ALBANY ST, NEW BRUNSWICK, NJ 08901-1914
(732) 235-4023
(732) 235-3299

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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