Provider Demographics
NPI:1932502143
Name:SCUDERI, PHIL
Entity Type:Individual
Prefix:
First Name:PHIL
Middle Name:
Last Name:SCUDERI
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 1:244 NE 94TH AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97220-4548
Mailing Address - Country:US
Mailing Address - Phone:503-544-8234
Mailing Address - Fax:
Practice Address - Street 1:244 NE 94TH AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97220-4548
Practice Address - Country:US
Practice Address - Phone:503-544-8234
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-01
Last Update Date:2014-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR200943192RN163WI0500X
WAES00117753163WI0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WI0500XNursing Service ProvidersRegistered NurseInfusion Therapy