Provider Demographics
NPI:1215215140
Name:SKYRM, MELISA (MAC LAC)
Entity Type:Individual
Prefix:MS
First Name:MELISA
Middle Name:
Last Name:SKYRM
Suffix:
Gender:F
Credentials:MAC LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2117 OLD MARLTON PIKE
Mailing Address - Street 2:
Mailing Address - City:CHERRY HILL
Mailing Address - State:NJ
Mailing Address - Zip Code:08003-1302
Mailing Address - Country:US
Mailing Address - Phone:856-424-2260
Mailing Address - Fax:
Practice Address - Street 1:2117 OLD MARLTON PIKE
Practice Address - Street 2:
Practice Address - City:CHERRY HILL
Practice Address - State:NJ
Practice Address - Zip Code:08003-1302
Practice Address - Country:US
Practice Address - Phone:856-424-2260
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-26
Last Update Date:2011-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MZ00077800171100000X
PAAK000967171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist