Provider Demographics
NPI:1144223173
Name:SCIULLO, ARMANDO C (DO)
Entity Type:Individual
Prefix:
First Name:ARMANDO
Middle Name:C
Last Name:SCIULLO
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:647 N BROAD STREET EXT STE 205
Mailing Address - Street 2:
Mailing Address - City:GROVE CITY
Mailing Address - State:PA
Mailing Address - Zip Code:16127-4604
Mailing Address - Country:US
Mailing Address - Phone:724-450-7004
Mailing Address - Fax:724-450-7013
Practice Address - Street 1:647 N BROAD STREET EXT STE 205
Practice Address - Street 2:
Practice Address - City:GROVE CITY
Practice Address - State:PA
Practice Address - Zip Code:16127-4604
Practice Address - Country:US
Practice Address - Phone:724-450-7004
Practice Address - Fax:724-450-7013
Is Sole Proprietor?:No
Enumeration Date:2005-05-23
Last Update Date:2020-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS009928L208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
11311733OtherCAQH
PA001924632Medicaid
PA001924632Medicaid