Provider Demographics
NPI:1356405815
Name:SKIDELL, SANDRA JO (PA-C)
Entity type:Individual
Prefix:
First Name:SANDRA
Middle Name:JO
Last Name:SKIDELL
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 1:1965 CAPITAL CIR NE
Mailing Address - Street 2:STE 200
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32308-8402
Mailing Address - Country:US
Mailing Address - Phone:850-656-2006
Mailing Address - Fax:850-656-2820
Practice Address - Street 1:2140 CENTERVILLE RD
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32308-4314
Practice Address - Country:US
Practice Address - Phone:850-383-3382
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-20
Last Update Date:2016-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA 2697363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLP 33970Medicare UPIN
FLE5699ZMedicare ID - Type Unspecified