Healthcare Provider Details

I. General information

NPI: 1720440688
Provider Name (Legal Business Name): DANIEL SKULLY APRN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/22/2016
Last Update Date: 03/22/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6100 ROCKSIDE WOODS BLVD N SUITE 425
INDEPENDENCE OH
44131-2366
US

IV. Provider business mailing address

6100 ROCKSIDE WOODS BLVD N
INDEPENDENCE OH
44131-2340
US

V. Phone/Fax

Practice location:
  • Phone: 216-643-2780
  • Fax: 216-524-0111
Mailing address:
  • Phone: 216-571-9822
  • Fax: 216-524-0111

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number08190
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: