Provider Demographics
NPI:1992702906
Name:SCUDERI, PHILIP J (DC)
Entity type:Individual
Prefix:
First Name:PHILIP
Middle Name:J
Last Name:SCUDERI
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4794 NORTHLAKE BLVD STE B
Mailing Address - Street 2:
Mailing Address - City:PALM BEACH GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33418-5910
Mailing Address - Country:US
Mailing Address - Phone:561-775-4900
Mailing Address - Fax:561-775-0003
Practice Address - Street 1:4794 NORTHLAKE BLVD STE B
Practice Address - Street 2:
Practice Address - City:PALM BEACH GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33418-5910
Practice Address - Country:US
Practice Address - Phone:561-775-4900
Practice Address - Fax:561-775-0003
Is Sole Proprietor?:No
Enumeration Date:2005-07-05
Last Update Date:2024-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH7741111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL55853ZMedicare ID - Type Unspecified
86389Medicare UPIN