Provider Demographics
NPI:1962979690
Name:SCOLARI, KHIARA FAY (PA)
Entity type:Individual
Prefix:
First Name:KHIARA
Middle Name:FAY
Last Name:SCOLARI
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:35 CHESTNUT HILL RD
Mailing Address - Street 2:
Mailing Address - City:CHELMSFORD
Mailing Address - State:MA
Mailing Address - Zip Code:01824-1935
Mailing Address - Country:US
Mailing Address - Phone:978-436-1018
Mailing Address - Fax:
Practice Address - Street 1:23929 MCBEAN PKWY STE 215
Practice Address - Street 2:
Practice Address - City:VALENCIA
Practice Address - State:CA
Practice Address - Zip Code:91355-4468
Practice Address - Country:US
Practice Address - Phone:661-799-2542
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-31
Last Update Date:2024-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY022945363A00000X
COPA.0007797363A00000X
CAPA62119363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant