Provider Demographics
NPI:1720052491
Name:SKEBE, ALLYSON LEIGH (PA-C)
Entity Type:Individual
Prefix:
First Name:ALLYSON
Middle Name:LEIGH
Last Name:SKEBE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:ALLYSON
Other - Middle Name:LEIGH
Other - Last Name:BRINDA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3755 ORANGE PL STE 101
Mailing Address - Street 2:
Mailing Address - City:BEACHWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:44122-4455
Mailing Address - Country:US
Mailing Address - Phone:844-746-8537
Mailing Address - Fax:216-450-1810
Practice Address - Street 1:3755 ORANGE PL STE 101
Practice Address - Street 2:
Practice Address - City:BEACHWOOD
Practice Address - State:OH
Practice Address - Zip Code:44122-4455
Practice Address - Country:US
Practice Address - Phone:844-746-8537
Practice Address - Fax:216-450-1810
Is Sole Proprietor?:No
Enumeration Date:2006-02-17
Last Update Date:2017-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH50.002696RX363AS0400X
PAMA052338363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0068424Medicaid
OH6184581OtherCIGNA
9177119OtherAETNA
OHCS1711001157OtherCARESOURCE
OHP01827113OtherRAILROAD MEDICARE
OHH081972OtherMEDICARE
OHCS1711001157OtherCARESOURCE
OHP00771654Medicare PIN