Provider Demographics
NPI:1902034648
Name:SCICCHITANO, DONALD CARL (RPA)
Entity Type:Individual
Prefix:
First Name:DONALD
Middle Name:CARL
Last Name:SCICCHITANO
Suffix:
Gender:M
Credentials:RPA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9897 W MCDOWELL RD STE 100
Mailing Address - Street 2:
Mailing Address - City:TOLLESON
Mailing Address - State:AZ
Mailing Address - Zip Code:85353-1622
Mailing Address - Country:US
Mailing Address - Phone:623-474-2300
Mailing Address - Fax:623-474-2306
Practice Address - Street 1:9897 W MCDOWELL RD STE 100
Practice Address - Street 2:
Practice Address - City:TOLLESON
Practice Address - State:AZ
Practice Address - Zip Code:85353-1622
Practice Address - Country:US
Practice Address - Phone:623-474-2300
Practice Address - Fax:623-474-2306
Is Sole Proprietor?:No
Enumeration Date:2009-07-01
Last Update Date:2019-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ6120363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ385553Medicaid
NYJ400097248/70008AMedicare PIN