Provider Demographics
NPI:1518111475
Name:SCOLARO, SHARRILL JEANNETTE (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:SHARRILL
Middle Name:JEANNETTE
Last Name:SCOLARO
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 70
Mailing Address - Street 2:
Mailing Address - City:OWEGO
Mailing Address - State:NY
Mailing Address - Zip Code:13827-0070
Mailing Address - Country:US
Mailing Address - Phone:607-687-5333
Mailing Address - Fax:607-687-4899
Practice Address - Street 1:110 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:OWEGO
Practice Address - State:NY
Practice Address - Zip Code:13827
Practice Address - Country:US
Practice Address - Phone:607-687-5333
Practice Address - Fax:607-687-4899
Is Sole Proprietor?:No
Enumeration Date:2008-11-05
Last Update Date:2019-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY012746363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03183795Medicaid