Provider Demographics
NPI:1124831722
Name:SCOOPO, ALICIA
Entity type:Individual
Prefix:
First Name:ALICIA
Middle Name:
Last Name:SCOOPO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:44 MAYAPPLE WAY
Mailing Address - Street 2:
Mailing Address - City:BALLSTON SPA
Mailing Address - State:NY
Mailing Address - Zip Code:12020-4389
Mailing Address - Country:US
Mailing Address - Phone:203-605-9568
Mailing Address - Fax:
Practice Address - Street 1:515 MOE RD
Practice Address - Street 2:
Practice Address - City:CLIFTON PARK
Practice Address - State:NY
Practice Address - Zip Code:12065-3821
Practice Address - Country:US
Practice Address - Phone:518-280-4294
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-28
Last Update Date:2025-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist