Provider Demographics
NPI:1407488349
Name:SCISCIANI, BETH A (MASLP)
Entity Type:Individual
Prefix:
First Name:BETH
Middle Name:A
Last Name:SCISCIANI
Suffix:
Gender:F
Credentials:MASLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8654 WALSHAM DR
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28277-1850
Mailing Address - Country:US
Mailing Address - Phone:704-572-9782
Mailing Address - Fax:
Practice Address - Street 1:8654 WALSHAM DR
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28277-1850
Practice Address - Country:US
Practice Address - Phone:704-572-9782
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-09
Last Update Date:2020-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2515208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics