=====================================================
General NPI Number Information
=====================================================
NPI Number | 1780741843
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SALLY BETH SCHKOLNIK D.P.M
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/01/2007
-----------------------------------------------------
Last Update Date | 08/12/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 30 SEVERANCE CIR APT 506
-----------------------------------------------------
City | CLEVELAND HEIGHTS
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44118-1527
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 216-291-6000
-----------------------------------------------------
Fax | 216-291-6013
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 30 SEVERANCE CIR APT 506
-----------------------------------------------------
City | CLEVELAND HEIGHTS
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44118-1527
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 216-291-6000
-----------------------------------------------------
Fax | 216-291-6013
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 213E00000X
-----------------------------------------------------
Taxonomy Name | Podiatrist
-----------------------------------------------------
License Number | 2317
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------