Healthcare Provider Details

I. General information

NPI: 1659328961
Provider Name (Legal Business Name): DARYLL C. DYKES MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/30/2006
Last Update Date: 08/06/2020
Certification Date: 08/06/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6620 FLY ROAD SUITE 200
EAST SYARUSE NY
13057
US

IV. Provider business mailing address

6620 FLY ROAD SUITE 200
EAST SYARUSE NY
13057
US

V. Phone/Fax

Practice location:
  • Phone: 315-464-3619
  • Fax: 315-464-5222
Mailing address:
  • Phone: 315-464-3619
  • Fax: 315-464-5222

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XS0117X
TaxonomyOrthopaedic Surgery of the Spine Physician
License Number292638-01
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number40550
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: