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NPI Code Detail

MEDICARE: DR. CYNTHIA DANIELLE SKELLY M.D.

MEDICARE: DR. CYNTHIA DANIELLE SKELLY M.D.
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
1208000000XPediatrics Physician102664FL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1366632523
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. CYNTHIA DANIELLE SKELLY M.D.
Provider Business Mailing Address
First Line : 317 E 20TH ST
Second Line :
City : ELK CITY
State : OK
Zip : 73644-6902
Country : US
Telephone Number : 386-213-2879
Fax Number :
Provider Business Practice Location Address
First Line : 10321 N 2274 RD
Second Line :
City : CLINTON
State : OK
Zip : 73601-7521
Country : US
Telephone Number : 580-331-3300
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/25/2007
Last Update Date : 12/14/2020

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