Provider Demographics
NPI:1407886989
Name:HALL SCUDERI, HEATHER (MD)
Entity Type:Individual
Prefix:DR
First Name:HEATHER
Middle Name:
Last Name:HALL SCUDERI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:HEATHER
Other - Middle Name:MARIE
Other - Last Name:HALL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:9370 STUDIO CT STE 100E
Mailing Address - Street 2:
Mailing Address - City:ELK GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:95758-8047
Mailing Address - Country:US
Mailing Address - Phone:916-747-2346
Mailing Address - Fax:916-747-0902
Practice Address - Street 1:9370 STUDIO CT STE 100E
Practice Address - Street 2:
Practice Address - City:ELK GROVE
Practice Address - State:CA
Practice Address - Zip Code:95758-8047
Practice Address - Country:US
Practice Address - Phone:916-747-2346
Practice Address - Fax:916-747-0902
Is Sole Proprietor?:No
Enumeration Date:2006-07-03
Last Update Date:2024-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG860392084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G860390OtherMEDICAL LICENSE
1407886989OtherNPI