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: 08/23/2026
Certification Date: 08/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4140 E BASELINE RD STE 211
MESA AZ
85206-4415
US

IV. Provider business mailing address

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

V. Phone/Fax

Practice location:
  • Phone: 480-273-8680
  • Fax: 480-306-7683
Mailing address:
  • Phone: 480-614-5406
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number009686
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: