Provider Demographics
NPI:1598514812
Name:SCARFULLERYS, IBIANCA
Entity type:Individual
Prefix:
First Name:IBIANCA
Middle Name:
Last Name:SCARFULLERYS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:IBIANCA
Other - Middle Name:
Other - Last Name:RAMOS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1501 S 17TH ST APT B115
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19146-4722
Mailing Address - Country:US
Mailing Address - Phone:297-901-2487
Mailing Address - Fax:
Practice Address - Street 1:1501 S 17TH ST APT B115
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19146-4722
Practice Address - Country:US
Practice Address - Phone:297-901-2487
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-17
Last Update Date:2024-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator