Provider Demographics
NPI:1518182211
Name:SKRYPKA, ANDY (CDE)
Entity Type:Individual
Prefix:
First Name:ANDY
Middle Name:
Last Name:SKRYPKA
Suffix:
Gender:F
Credentials:CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:365 TESCONI CIRCLE, SUITE B
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95401
Mailing Address - Country:US
Mailing Address - Phone:707-575-6043
Mailing Address - Fax:707-575-1060
Practice Address - Street 1:365 TESCONI CIRCLE, SUITE B
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95401
Practice Address - Country:US
Practice Address - Phone:707-575-6043
Practice Address - Fax:707-575-1060
Is Sole Proprietor?:No
Enumeration Date:2007-04-16
Last Update Date:2013-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA707414133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA707414OtherREGISTERED DIETICIAN
CAZZZ42777ZMedicare UPIN
CAZZZ24115ZMedicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER