Provider Demographics
NPI:1871216101
Name:SKULTETY, EVELYN (DTCM, LAC, CFMC)
Entity type:Individual
Prefix:
First Name:EVELYN
Middle Name:
Last Name:SKULTETY
Suffix:
Gender:
Credentials:DTCM, LAC, CFMC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:52 TANGLEWOOD TRL
Mailing Address - Street 2:
Mailing Address - City:SANTA CRUZ
Mailing Address - State:CA
Mailing Address - Zip Code:95060-1432
Mailing Address - Country:US
Mailing Address - Phone:831-600-6321
Mailing Address - Fax:
Practice Address - Street 1:52 TANGLEWOOD TRL
Practice Address - Street 2:
Practice Address - City:SANTA CRUZ
Practice Address - State:CA
Practice Address - Zip Code:95060-1432
Practice Address - Country:US
Practice Address - Phone:831-600-6321
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-21
Last Update Date:2025-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA19178171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty