MEDICARE: SKDG CORPORATION

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	225X00000X	Occupational Therapist

General Provider Information

NPI Number	:	1346002656
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SKDG CORPORATION

Provider Business Mailing Address
First Line	:	38 6TH AVE APT 1511
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11217-4243
Country	:	US
Telephone Number	:	347-907-9003
Fax Number	:

Provider Business Practice Location Address
First Line	:	38 6TH AVE APT 1511
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11217-4243
Country	:	US
Telephone Number	:	347-907-9003
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	SHARON KAY GANOTICE
Credential	:
Telephone Number	:	347-907-9003

Provider Enumeration Date	:	01/23/2024
Last Update Date	:	01/23/2024

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