Provider Demographics
NPI:1336769066
Name:DEAN, SKY HANNAH (MD)
Entity type:Individual
Prefix:
First Name:SKY
Middle Name:HANNAH
Last Name:DEAN
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 1:9772 DIAGONAL RD
Mailing Address - Street 2:
Mailing Address - City:MANTUA
Mailing Address - State:OH
Mailing Address - Zip Code:44255-9160
Mailing Address - Country:US
Mailing Address - Phone:330-732-8230
Mailing Address - Fax:
Practice Address - Street 1:9772 DIAGONAL RD
Practice Address - Street 2:
Practice Address - City:MANTUA
Practice Address - State:OH
Practice Address - Zip Code:44255-9160
Practice Address - Country:US
Practice Address - Phone:330-732-8230
Practice Address - Fax:330-732-2463
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-22
Last Update Date:2024-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.147599208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty