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General NPI Number Information
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NPI Number | 1306450416
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Entity Type | Organization
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Legal Business Name | SKANEATELES PSYCHIATRY, PLLC
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Dates
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Enumeration Date | 09/04/2020
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Last Update Date | 09/04/2020
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Provider Practice Location Address
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Address Line | 4361 JORDAN RD
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City | SKANEATELES
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State | NY
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Zip | 13152-9334
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Country | US
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Telephone | 315-685-5157
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Fax |
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Provider Business Mailing Address
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Address Line | 4361 JORDAN RD
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City | SKANEATELES
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State | NY
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Zip | 13152-9334
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Country | US
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Telephone | 315-685-5157
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. OLUMUYIWA GAY
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Credential | MD
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Telephone | 315-857-5971
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number |
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License Number State |
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