MEDICARE: MISS ERIN KATHERINE SKELLY RPA-C

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	363A00000X	Physician Assistant	23 014320	NY

General Provider Information

NPI Number	:	1518276682
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS ERIN KATHERINE SKELLY RPA-C

Provider Business Mailing Address
First Line	:	3709 ERIE BLVD E
Second Line	:
City	:	DE WITT
State	:	NY
Zip	:	13214-2227
Country	:	US
Telephone Number	:	315-251-2244
Fax Number	:	315-251-2240

Provider Business Practice Location Address
First Line	:	3709 ERIE BLVD E
Second Line	:
City	:	DE WITT
State	:	NY
Zip	:	13214-2227
Country	:	US
Telephone Number	:	315-251-2244
Fax Number	:	315-251-2240

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

Provider Enumeration Date	:	10/06/2010
Last Update Date	:	05/06/2013

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