Healthcare Provider Details

I. General information

NPI: 1588124135
Provider Name (Legal Business Name): CAMILLE CAY SKODA RDN, LD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/20/2019
Last Update Date: 03/20/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9500 EUCLID AVE
CLEVELAND OH
44195-0001
US

IV. Provider business mailing address

345 MINER RD
HIGHLAND HEIGHTS OH
44143-1536
US

V. Phone/Fax

Practice location:
  • Phone: 216-445-6900
  • Fax: 216-636-3074
Mailing address:
  • Phone: 440-554-7332
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberLD.8150
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: