Provider Demographics
NPI:1699016097
Name:CONNELLY, SKY LILLIAN SARAH (CPM, LM)
Entity Type:Individual
Prefix:
First Name:SKY
Middle Name:LILLIAN SARAH
Last Name:CONNELLY
Suffix:
Gender:F
Credentials:CPM, LM
Other - Prefix:
Other - First Name:SKY
Other - Middle Name:
Other - Last Name:CONNELLY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:CPM, LM
Mailing Address - Street 1:484 HOALA DR
Mailing Address - Street 2:
Mailing Address - City:KIHEI
Mailing Address - State:HI
Mailing Address - Zip Code:96753-9438
Mailing Address - Country:US
Mailing Address - Phone:949-391-2352
Mailing Address - Fax:760-452-7516
Practice Address - Street 1:484 HOALA DR
Practice Address - Street 2:
Practice Address - City:KIHEI
Practice Address - State:HI
Practice Address - Zip Code:96753
Practice Address - Country:US
Practice Address - Phone:949-391-2352
Practice Address - Fax:760-452-7516
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-09
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife
No374J00000XNursing Service Related ProvidersDoula