Provider Demographics
NPI:1356937825
Name:SKORDYNSKI, MARA (PA-C)
Entity type:Individual
Prefix:
First Name:MARA
Middle Name:
Last Name:SKORDYNSKI
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:41 RIVERWOOD DR
Mailing Address - Street 2:
Mailing Address - City:PINE CITY
Mailing Address - State:NY
Mailing Address - Zip Code:14871-9655
Mailing Address - Country:US
Mailing Address - Phone:607-331-6090
Mailing Address - Fax:
Practice Address - Street 1:830 COUNTY ROAD 64
Practice Address - Street 2:
Practice Address - City:ELMIRA
Practice Address - State:NY
Practice Address - Zip Code:14903-9719
Practice Address - Country:US
Practice Address - Phone:607-846-2030
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-17
Last Update Date:2020-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant