MEDICARE: DYLAN HACKNEY CT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	390200000X	Student in an Organized Health Care Education/Training Program		OH

General Provider Information

NPI Number	:	1184554925
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DYLAN HACKNEY CT

Provider Business Mailing Address
First Line	:	3500 LORAIN AVE STE 407
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44113-3726
Country	:	US
Telephone Number	:	216-250-1607
Fax Number	:	216-304-6669

Provider Business Practice Location Address
First Line	:	3500 LORAIN AVE STE 407
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44113-3726
Country	:	US
Telephone Number	:	216-250-1607
Fax Number	:	216-304-6669

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/22/2026
Last Update Date	:	05/22/2026

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Directions to “ DYLAN HACKNEY CT” Practice Location

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