Provider Demographics
NPI:1619515889
Name:SCAVUZZO, KATELYN ROSE
Entity Type:Individual
Prefix:
First Name:KATELYN
Middle Name:ROSE
Last Name:SCAVUZZO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:115 POINDEXTER DR UNIT 6203
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28203-6430
Mailing Address - Country:US
Mailing Address - Phone:216-548-4375
Mailing Address - Fax:
Practice Address - Street 1:238 LEHIGH AVE APT 2
Practice Address - Street 2:
Practice Address - City:SHADYSIDE
Practice Address - State:PA
Practice Address - Zip Code:15232-2089
Practice Address - Country:US
Practice Address - Phone:216-548-4375
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-12-18
Last Update Date:2023-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
NC131350367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program