Provider Demographics
NPI:1568459592
Name:NADENIK, SCOTT A (DO)
Entity Type:Individual
Prefix:
First Name:SCOTT
Middle Name:A
Last Name:NADENIK
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2120 SW 22ND PL
Mailing Address - Street 2:
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34471-7765
Mailing Address - Country:US
Mailing Address - Phone:352-732-5042
Mailing Address - Fax:352-732-6031
Practice Address - Street 1:2120 SW 22ND PL
Practice Address - Street 2:
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34471-7765
Practice Address - Country:US
Practice Address - Phone:352-732-5042
Practice Address - Fax:352-732-6031
Is Sole Proprietor?:No
Enumeration Date:2005-10-04
Last Update Date:2020-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS0007636207YX0905X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207YX0905XAllopathic & Osteopathic PhysiciansOtolaryngologyOtolaryngology/Facial Plastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL254812700Medicaid
FL4544150OtherAETNA PROVIDER NUMBER
FL146961OtherHEALTHEASE/WELLCARE
FL56727OtherBLUE CROSS PROVIDER #
FL243186OtherAVMED PROVIDER NUMBER
FL040012994OtherRAILROAD MEDICARE NUMBER
FL243186OtherAVMED PROVIDER NUMBER
FL4544150OtherAETNA PROVIDER NUMBER