Provider Demographics
NPI:1255548491
Name:VANSKYHAWK, DANIEL WAYNE II (IDC)
Entity type:Individual
Prefix:
First Name:DANIEL
Middle Name:WAYNE
Last Name:VANSKYHAWK
Suffix:II
Gender:M
Credentials:IDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:414 CONCORD RD
Mailing Address - Street 2:
Mailing Address - City:PORTSMOUTH
Mailing Address - State:VA
Mailing Address - Zip Code:23701-2231
Mailing Address - Country:US
Mailing Address - Phone:757-537-3813
Mailing Address - Fax:
Practice Address - Street 1:414 CONCORD RD
Practice Address - Street 2:
Practice Address - City:PORTSMOUTH
Practice Address - State:VA
Practice Address - Zip Code:23701-2231
Practice Address - Country:US
Practice Address - Phone:757-537-3813
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA17101003X1710I1003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1003XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Medical Technicians