Provider Demographics
NPI:1235101536
Name:OLEXY, S SCOTT (PA-C)
Entity Type:Individual
Prefix:
First Name:S
Middle Name:SCOTT
Last Name:OLEXY
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:STANLEY
Other - Middle Name:SCOTT
Other - Last Name:OLEXY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PA-C
Mailing Address - Street 1:1636 REGULUS AVE
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23461-2200
Mailing Address - Country:US
Mailing Address - Phone:757-893-2015
Mailing Address - Fax:
Practice Address - Street 1:1636 REGULUS AVE
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23461-2200
Practice Address - Country:US
Practice Address - Phone:757-893-2015
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-02
Last Update Date:2009-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9103313363A00000X
VA0110002649363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL292202900Medicaid
U5846Medicare ID - Type Unspecified
FL292202900Medicaid