Provider Demographics
NPI:1811971500
Name:SCAGNELLI, SARAH ANN (PA)
Entity type:Individual
Prefix:MS
First Name:SARAH
Middle Name:ANN
Last Name:SCAGNELLI
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8022 N 11TH AVE
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85021-5627
Mailing Address - Country:US
Mailing Address - Phone:602-254-3411
Mailing Address - Fax:602-254-3411
Practice Address - Street 1:5102 W CAMPBELL AVE
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85031-1703
Practice Address - Country:US
Practice Address - Phone:623-848-5000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-12-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ1880207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ3987220OtherEVERCARE
AZAZ0728670OtherBLUE CROSS/BLUE SHIELD
AZA101436OtherHEALTHNET
AZ642050Medicaid
AZ3987220OtherEVERCARE
AZAZ0728670OtherBLUE CROSS/BLUE SHIELD