Healthcare Provider Details

I. General information

NPI: 1265420061
Provider Name (Legal Business Name): THERESA ANNE SKELLY PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/06/2005
Last Update Date: 04/01/2021
Certification Date: 03/09/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

NORTHERN DUTCHESS HOSPITAL 6511 SPRING BROOK AVENUE
RHINEBECK NY
12572
US

IV. Provider business mailing address

NUVANCE HEALTH 1351 ROUTE 55, SUITE 200
LAGRANGEVILLE NY
12540
US

V. Phone/Fax

Practice location:
  • Phone: 845-876-3001
  • Fax:
Mailing address:
  • Phone: 845-475-9500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number2947
License Number StateCT
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number014910
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number025130
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: