Provider Demographics
NPI:1417451485
Name:SKORY, STEVEN PAUL
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:PAUL
Last Name:SKORY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9540 COVE DR UNIT D4
Mailing Address - Street 2:
Mailing Address - City:NORTH ROYALTON
Mailing Address - State:OH
Mailing Address - Zip Code:44133-2780
Mailing Address - Country:US
Mailing Address - Phone:510-290-6161
Mailing Address - Fax:
Practice Address - Street 1:9540 COVE DR UNIT D4
Practice Address - Street 2:
Practice Address - City:NORTH ROYALTON
Practice Address - State:OH
Practice Address - Zip Code:44133-2780
Practice Address - Country:US
Practice Address - Phone:510-290-6161
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-22
Last Update Date:2018-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH0249610374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0249610Medicaid