Healthcare Provider Details

I. General information

NPI: 1417182270
Provider Name (Legal Business Name): CASSIDY G SYKOLA CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/22/2009
Last Update Date: 03/16/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 STATE ST
ERIE PA
16507-1420
US

IV. Provider business mailing address

3998 FAIR RIDGE DRIVE, SUITE 300
FAIRFAX VA
22033
US

V. Phone/Fax

Practice location:
  • Phone: 814-453-3900
  • Fax: 814-453-2847
Mailing address:
  • Phone: 703-766-9694
  • Fax: 703-293-9592

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberRN515976L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: