Provider Demographics
NPI:1972523207
Name:SCUTT, HENCY (NP,)
Entity type:Individual
Prefix:
First Name:HENCY
Middle Name:
Last Name:SCUTT
Suffix:
Gender:F
Credentials:NP,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:355 OVINGTON AVE
Mailing Address - Street 2:SUITE 203
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11209-1483
Mailing Address - Country:US
Mailing Address - Phone:718-759-0109
Mailing Address - Fax:718-759-0101
Practice Address - Street 1:355 OVINGTON AVE
Practice Address - Street 2:SUITE 203
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11209-1483
Practice Address - Country:US
Practice Address - Phone:718-759-0109
Practice Address - Fax:718-759-0101
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-20
Last Update Date:2016-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF303384208VP0000X, 363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02621281Medicaid
NYQ35578Medicare UPIN
NY0955G1Medicare ID - Type Unspecified