Provider Demographics
NPI:1841248887
Name:SKIRK, DIANA I (MD)
Entity type:Individual
Prefix:DR
First Name:DIANA
Middle Name:I
Last Name:SKIRK
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 1:240 N WICKHAM RD
Mailing Address - Street 2:SUITE 110
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32935-8662
Mailing Address - Country:US
Mailing Address - Phone:321-757-7776
Mailing Address - Fax:321-757-7343
Practice Address - Street 1:2571W EAU GALLIE BLVD
Practice Address - Street 2:SUITE 4
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32935-8302
Practice Address - Country:US
Practice Address - Phone:321-757-7776
Practice Address - Fax:321-757-7343
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-04
Last Update Date:2022-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME00894472084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL270169300Medicaid
FL48156AMedicare ID - Type UnspecifiedMEDICARE
FL270169300Medicaid