Healthcare Provider Details

I. General information

NPI: 1184554925
Provider Name (Legal Business Name): DYLAN HACKNEY CT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/22/2026
Last Update Date: 05/22/2026
Certification Date: 05/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3500 LORAIN AVE STE 407
CLEVELAND OH
44113-3726
US

IV. Provider business mailing address

3500 LORAIN AVE STE 407
CLEVELAND OH
44113-3726
US

V. Phone/Fax

Practice location:
  • Phone: 216-250-1607
  • Fax: 216-304-6669
Mailing address:
  • Phone: 216-250-1607
  • Fax: 216-304-6669

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: