Healthcare Provider Details

I. General information

NPI: 1285050575
Provider Name (Legal Business Name): SKYLER W NIELSEN D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/11/2014
Last Update Date: 04/21/2023
Certification Date: 04/21/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

726 N GREENFIELD RD STE 101
GILBERT AZ
85234-5062
US

IV. Provider business mailing address

9097 E DESERT COVE AVE STE 200
SCOTTSDALE AZ
85260-6280
US

V. Phone/Fax

Practice location:
  • Phone: 480-833-8620
  • Fax: 480-969-3952
Mailing address:
  • Phone: 480-614-5406
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number1418
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: