Provider Demographics
NPI:1780283242
Name:SCALZO, ELIZABETH MARIE (FNP)
Entity type:Individual
Prefix:MS
First Name:ELIZABETH
Middle Name:MARIE
Last Name:SCALZO
Suffix:
Gender:F
Credentials:FNP
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Mailing Address - Street 1:96 HOLST DR W
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON
Mailing Address - State:NY
Mailing Address - Zip Code:11743-3940
Mailing Address - Country:US
Mailing Address - Phone:631-790-9387
Mailing Address - Fax:
Practice Address - Street 1:111 BEACH DR
Practice Address - Street 2:
Practice Address - City:WEST ISLIP
Practice Address - State:NY
Practice Address - Zip Code:11795-4929
Practice Address - Country:US
Practice Address - Phone:314-178-6006
Practice Address - Fax:631-666-0684
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-25
Last Update Date:2022-11-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NYF346401-01363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty