Provider Demographics
NPI:1508145665
Name:SCIULLI, JESSICA (DPM)
Entity Type:Individual
Prefix:DR
First Name:JESSICA
Middle Name:
Last Name:SCIULLI
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1629 OVERTON LN
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15217-3507
Mailing Address - Country:US
Mailing Address - Phone:412-228-5509
Mailing Address - Fax:412-906-9929
Practice Address - Street 1:2027 LEBANON CHURCH RD
Practice Address - Street 2:
Practice Address - City:WEST MIFFLIN
Practice Address - State:PA
Practice Address - Zip Code:15122-2461
Practice Address - Country:US
Practice Address - Phone:412-228-5509
Practice Address - Fax:412-906-9929
Is Sole Proprietor?:No
Enumeration Date:2011-08-08
Last Update Date:2016-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASC006439213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA102835745Medicaid
PAP01318738Medicare PIN
PA316825YVFXMedicare PIN