Provider Demographics
NPI:1750038287
Name:HARRIS, SKYE (RDN)
Entity Type:Individual
Prefix:
First Name:SKYE
Middle Name:
Last Name:HARRIS
Suffix:
Gender:F
Credentials:RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:124 LAUREL WAY APT 3A
Mailing Address - Street 2:
Mailing Address - City:HERNDON
Mailing Address - State:VA
Mailing Address - Zip Code:20170-4409
Mailing Address - Country:US
Mailing Address - Phone:757-677-6360
Mailing Address - Fax:
Practice Address - Street 1:2 CARDINAL PARK DR SE STE 104A
Practice Address - Street 2:
Practice Address - City:LEESBURG
Practice Address - State:VA
Practice Address - Zip Code:20175-4448
Practice Address - Country:US
Practice Address - Phone:571-310-6029
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-04
Last Update Date:2022-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered