Provider Demographics
NPI:1114602950
Name:SCANGARELLO, BERET ANYA (MS)
Entity Type:Individual
Prefix:
First Name:BERET
Middle Name:ANYA
Last Name:SCANGARELLO
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6361 ARAGON WAY APT 205
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33966-4770
Mailing Address - Country:US
Mailing Address - Phone:917-674-6102
Mailing Address - Fax:
Practice Address - Street 1:6361 ARAGON WAY APT 205
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33966-4770
Practice Address - Country:US
Practice Address - Phone:917-674-6102
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-20
Last Update Date:2023-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist