Provider Demographics
NPI:1669689311
Name:SCACCIA, MARCELLA (MD)
Entity type:Individual
Prefix:
First Name:MARCELLA
Middle Name:
Last Name:SCACCIA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2937 S ATLANTIC AVE APT 602
Mailing Address - Street 2:
Mailing Address - City:DAYTONA BEACH SHORES
Mailing Address - State:FL
Mailing Address - Zip Code:32118-6045
Mailing Address - Country:US
Mailing Address - Phone:386-871-4515
Mailing Address - Fax:
Practice Address - Street 1:2937 S ATLANTIC AVE APT 602
Practice Address - Street 2:
Practice Address - City:DAYTONA BEACH SHORES
Practice Address - State:FL
Practice Address - Zip Code:32118-6045
Practice Address - Country:US
Practice Address - Phone:386-871-4515
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-16
Last Update Date:2023-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY241739207QG0300X
FL109319207QG0300X, 207QH0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QH0002XAllopathic & Osteopathic PhysiciansFamily MedicineHospice and Palliative Medicine
No207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric Medicine