Provider Demographics
NPI:1033154398
Name:SCIULLI, ROBERT R JR (PA-C)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:R
Last Name:SCIULLI
Suffix:JR
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:281 N LYERLY ST STE 200
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37404-2749
Mailing Address - Country:US
Mailing Address - Phone:423-698-0850
Mailing Address - Fax:423-698-0511
Practice Address - Street 1:281 N LYERLY ST STE 200
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37404-2749
Practice Address - Country:US
Practice Address - Phone:423-698-0850
Practice Address - Fax:423-698-0511
Is Sole Proprietor?:No
Enumeration Date:2006-06-19
Last Update Date:2024-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1604363A00000X
MI5601001899363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIR81183Medicare UPIN