Provider Demographics
NPI:1639634090
Name:DAMANTI, SCOTT T
Entity Type:Individual
Prefix:
First Name:SCOTT
Middle Name:T
Last Name:DAMANTI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1171 NE CLEVELAND ST
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33755-4815
Mailing Address - Country:US
Mailing Address - Phone:727-447-6442
Mailing Address - Fax:
Practice Address - Street 1:1171 NE CLEVELAND ST
Practice Address - Street 2:
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33755-4815
Practice Address - Country:US
Practice Address - Phone:727-447-6442
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-09
Last Update Date:2019-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL8894111NN1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NN1001XChiropractic ProvidersChiropractorNutritionGroup - Single Specialty