Provider Demographics
NPI:1023081692
Name:SKOLNIK, PHYLLIS (MD)
Entity type:Individual
Prefix:DR
First Name:PHYLLIS
Middle Name:
Last Name:SKOLNIK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8740 N KENDALL DR STE 101
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33176-2209
Mailing Address - Country:US
Mailing Address - Phone:305-661-8978
Mailing Address - Fax:305-661-0193
Practice Address - Street 1:8740 N KENDALL DR STE 101
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33176-2209
Practice Address - Country:US
Practice Address - Phone:305-661-8978
Practice Address - Fax:305-661-0193
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-13
Last Update Date:2023-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL21557207N00000X, 207NS0135X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural Dermatology
No207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL049850500Medicaid
FLD60169Medicare UPIN
FL049850500Medicaid