Provider Demographics
NPI:1881013886
Name:SKELLY, SARAH (DO)
Entity Type:Individual
Prefix:DR
First Name:SARAH
Middle Name:
Last Name:SKELLY
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2045 FOUNTAIN PROFESSIONAL CT STE C
Mailing Address - Street 2:
Mailing Address - City:NAVARRE
Mailing Address - State:FL
Mailing Address - Zip Code:32566-5108
Mailing Address - Country:US
Mailing Address - Phone:850-407-1914
Mailing Address - Fax:800-867-9259
Practice Address - Street 1:2045 FOUNTAIN PROFESSIONAL CT STE C
Practice Address - Street 2:
Practice Address - City:NAVARRE
Practice Address - State:FL
Practice Address - Zip Code:32566-5108
Practice Address - Country:US
Practice Address - Phone:850-407-1914
Practice Address - Fax:800-867-9259
Is Sole Proprietor?:No
Enumeration Date:2014-04-08
Last Update Date:2023-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
FLOS14425207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program