Basic Information
| Provider Information | |||||||||
| NPI: | 1184011355 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SCUTERI | ||||||||
| FirstName: | BRYAN | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D.,M.B.A. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6804 CECELIA DR | ||||||||
| Address2: | |||||||||
| City: | NEW PORT RICHEY | ||||||||
| State: | FL | ||||||||
| PostalCode: | 346534935 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8552320644 | ||||||||
| FaxNumber: | 8885460488 | ||||||||
| Practice Location | |||||||||
| Address1: | 5045 FRUITVILLE RD STE 123 | ||||||||
| Address2: | |||||||||
| City: | SARASOTA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 342322269 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7272034613 | ||||||||
| FaxNumber: | 7272034613 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/24/2015 | ||||||||
| LastUpdateDate: | 09/07/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 09/07/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207QS1201X | 309582 | LA | N | Allopathic & Osteopathic Physicians | Family Medicine | Sleep Medicine | 207QS1201X | ME141518 | FL | Y | Allopathic & Osteopathic Physicians | Family Medicine | Sleep Medicine |
ID Information
| ID | Type | State | Issuer | Description | 106728400 | 05 | FL | MEDICAID |