Provider Demographics
NPI:1093819583
Name:SCIALLI, JOHN VINCENT (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:VINCENT
Last Name:SCIALLI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4647 N 32ND ST
Mailing Address - Street 2:STE 260
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85018-3344
Mailing Address - Country:US
Mailing Address - Phone:602-224-9888
Mailing Address - Fax:602-224-5304
Practice Address - Street 1:4647 N 32ND ST
Practice Address - Street 2:STE 260
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85018-3344
Practice Address - Country:US
Practice Address - Phone:602-224-9888
Practice Address - Fax:602-224-5304
Is Sole Proprietor?:No
Enumeration Date:2006-09-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ137792084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
D00279Medicare UPIN