Provider Demographics
NPI:1659328961
Name:DYKES, DARYLL C (MD)
Entity Type:Individual
Prefix:DR
First Name:DARYLL
Middle Name:C
Last Name:DYKES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:6620 FLY ROAD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:EAST SYARUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13057
Mailing Address - Country:US
Mailing Address - Phone:315-464-3619
Mailing Address - Fax:315-464-5222
Practice Address - Street 1:6620 FLY ROAD
Practice Address - Street 2:SUITE 200
Practice Address - City:EAST SYARUSE
Practice Address - State:NY
Practice Address - Zip Code:13057
Practice Address - Country:US
Practice Address - Phone:315-464-3619
Practice Address - Fax:315-464-5222
Is Sole Proprietor?:No
Enumeration Date:2006-05-30
Last Update Date:2020-08-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY292638-01207XS0117X
MN40550174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0117XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the Spine
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN876483200Medicaid
NY05268328Medicaid
MN200001803Medicare ID - Type Unspecified