Provider Demographics
NPI:1114183399
Name:SCAVO, CHRISTINA (FNP)
Entity Type:Individual
Prefix:MRS
First Name:CHRISTINA
Middle Name:
Last Name:SCAVO
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:MRS
Other - First Name:CHRISTINA
Other - Middle Name:
Other - Last Name:SCAVO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:FNP
Mailing Address - Street 1:568 NASSAU AVE
Mailing Address - Street 2:
Mailing Address - City:FREEPORT
Mailing Address - State:NY
Mailing Address - Zip Code:11520-6321
Mailing Address - Country:US
Mailing Address - Phone:516-637-3985
Mailing Address - Fax:
Practice Address - Street 1:31 MERRICK AVE STE 10
Practice Address - Street 2:
Practice Address - City:MERRICK
Practice Address - State:NY
Practice Address - Zip Code:11566-3406
Practice Address - Country:US
Practice Address - Phone:516-776-8062
Practice Address - Fax:888-608-7845
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-06
Last Update Date:2022-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY349436363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily