Provider Demographics
NPI:1033281365
Name:SKILES, SUNNIE LEE (MD)
Entity Type:Individual
Prefix:
First Name:SUNNIE
Middle Name:LEE
Last Name:SKILES
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 1:6815 FIVE STAR BLVD STE 100
Mailing Address - Street 2:
Mailing Address - City:ROCKLIN
Mailing Address - State:CA
Mailing Address - Zip Code:95677-2691
Mailing Address - Country:US
Mailing Address - Phone:916-626-3060
Mailing Address - Fax:916-626-3063
Practice Address - Street 1:6815 FIVE STAR BLVD STE 100
Practice Address - Street 2:
Practice Address - City:ROCKLIN
Practice Address - State:CA
Practice Address - Zip Code:95677
Practice Address - Country:US
Practice Address - Phone:916-626-3060
Practice Address - Fax:916-626-3063
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-14
Last Update Date:2018-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG66133208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA44802Medicaid
A44802Medicare UPIN