Provider Demographics
NPI:1174494678
Name:FLYNN, DYLAN T
Entity type:Individual
Prefix:
First Name:DYLAN
Middle Name:T
Last Name:FLYNN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1208 FOREST HILLS DR
Mailing Address - Street 2:
Mailing Address - City:VINCENNES
Mailing Address - State:IN
Mailing Address - Zip Code:47591-3602
Mailing Address - Country:US
Mailing Address - Phone:812-899-0012
Mailing Address - Fax:
Practice Address - Street 1:1208 FOREST HILLS DR
Practice Address - Street 2:
Practice Address - City:VINCENNES
Practice Address - State:IN
Practice Address - Zip Code:47591-3602
Practice Address - Country:US
Practice Address - Phone:812-899-0012
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-09-16
Last Update Date:2025-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program