Tyler Isaac Scicchitano, PA-C

Primary specialty

Medical Physician AssistantTaxonomy code 363AM0700X

License

MA060996 Issued in PA

Practice address

5 White Owl Ave
Mahanoy City, PA 17948-3000

Phone

(570) 773-5388

NPI assigned

Sep 11, 2019

Last updated

Mar 16, 2023By the provider in NPPES

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

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  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1568160000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1678924800000",
    "number": "1730738709",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5 WHITE OWL AVE",
            "city": "MAHANOY CITY",
            "state": "PA",
            "postal_code": "179483000",
            "telephone_number": "866-345-1543"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5 WHITE OWL AVE",
            "city": "MAHANOY CITY",
            "state": "PA",
            "postal_code": "179483000",
            "telephone_number": "570-773-5388"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "161 Cecil B Moore",
            "address_2": "Suite 204",
            "address_purpose": "LOCATION",
            "city": "Philadelphia",
            "state": "PA",
            "postal_code": "191223243",
            "country_code": "US",
            "telephone_number": "215-585-2144",
            "fax_number": "267-780-7032",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "801 West Bay Drive",
            "address_2": "Suite 408",
            "address_purpose": "LOCATION",
            "city": "Largo",
            "state": "FL",
            "postal_code": "337703220",
            "country_code": "US",
            "telephone_number": "215-585-2144",
            "fax_number": "267-780-7032",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SCICCHITANO",
        "first_name": "TYLER",
        "middle_name": "ISAAC",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2019-09-11",
        "last_updated": "2023-03-16",
        "certification_date": "2023-03-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "PA",
            "license": "MA060996",
            "primary": true
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "PA",
            "license": "MA060996",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Eric Evan Petterson, MD
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• Professional Counseling Consulting & Human Services LLC (New Beginnings Centers)
• Rite Aid of Pennsylvania LLC (Rite Aid Pharmacy 00696)
• Riteaid Pharmacy
• Gursharan Singh, MD
• The Progressions Companies, Inc.
• Kayla Weeden, CRNP
• Leah Marie Weidner, CRNP

• Medical Physician Assistant in Mahanoy City, PA
• Providers in Mahanoy City, PA by specialty
• Medical Physician Assistant in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 16, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.