Provider Demographics
NPI:1902385255
Name:SCIAMANDA TOTAL HEALTH AND WELLNESS
Entity Type:Organization
Organization Name:SCIAMANDA TOTAL HEALTH AND WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DOMINIC
Authorized Official - Middle Name:MARIANO
Authorized Official - Last Name:SCIAMANDA
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:814-456-1097
Mailing Address - Street 1:1920 W 8TH ST
Mailing Address - Street 2:
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16505-4935
Mailing Address - Country:US
Mailing Address - Phone:814-456-1097
Mailing Address - Fax:814-287-9375
Practice Address - Street 1:1920 W 8TH ST
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16505-4935
Practice Address - Country:US
Practice Address - Phone:814-456-1097
Practice Address - Fax:814-287-9375
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-08
Last Update Date:2021-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS018175207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty