Healthcare Provider Details

I. General information

NPI: 1649114943
Provider Name (Legal Business Name): NATHAN SQUILLANTE
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/16/2026
Last Update Date: 04/16/2026
Certification Date: 04/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5050 MADISON RD
CINCINNATI OH
45227-1491
US

IV. Provider business mailing address

3287 MORRISON AVE APT 4
CINCINNATI OH
45220-1946
US

V. Phone/Fax

Practice location:
  • Phone: 513-272-2800
  • Fax: 513-272-7807
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: