Provider Demographics
NPI:1720440688
Name:SKULLY, DANIEL (APRN)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:
Last Name:SKULLY
Suffix:
Gender:M
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6100 ROCKSIDE WOODS BLVD N
Mailing Address - Street 2:
Mailing Address - City:INDEPENDENCE
Mailing Address - State:OH
Mailing Address - Zip Code:44131-2340
Mailing Address - Country:US
Mailing Address - Phone:216-571-9822
Mailing Address - Fax:216-524-0111
Practice Address - Street 1:6100 ROCKSIDE WOODS BLVD N
Practice Address - Street 2:SUITE 425
Practice Address - City:INDEPENDENCE
Practice Address - State:OH
Practice Address - Zip Code:44131-2366
Practice Address - Country:US
Practice Address - Phone:216-643-2780
Practice Address - Fax:216-524-0111
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-22
Last Update Date:2016-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH08190363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health