Provider Demographics
NPI:1326336959
Name:MARCELLA SCACCIA PHYSICIAN PLLC
Entity Type:Organization
Organization Name:MARCELLA SCACCIA PHYSICIAN PLLC
Other - Org Name:TOTAL WELLNESS & HEALTHY AGING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MARCELLA
Authorized Official - Middle Name:
Authorized Official - Last Name:SCACCIA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:386-871-0675
Mailing Address - Street 1:2922 SEA OATS CIR
Mailing Address - Street 2:
Mailing Address - City:DAYTONA BEACH SHORES
Mailing Address - State:FL
Mailing Address - Zip Code:32118-5938
Mailing Address - Country:US
Mailing Address - Phone:386-871-0675
Mailing Address - Fax:386-767-9085
Practice Address - Street 1:2540 SHORE BLVD
Practice Address - Street 2:12B
Practice Address - City:ASTORIA
Practice Address - State:NY
Practice Address - Zip Code:11102-3941
Practice Address - Country:US
Practice Address - Phone:386-871-4515
Practice Address - Fax:386-767-9085
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-18
Last Update Date:2011-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY241739207QG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric MedicineGroup - Single Specialty