Provider Demographics
NPI:1912536889
Name:ALTAIRE, SKYE (DO)
Entity Type:Individual
Prefix:
First Name:SKYE
Middle Name:
Last Name:ALTAIRE
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:SKYE
Other - Middle Name:
Other - Last Name:MILLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:455 WOODVIEW RD STE 100
Mailing Address - Street 2:
Mailing Address - City:WEST GROVE
Mailing Address - State:PA
Mailing Address - Zip Code:19390-9314
Mailing Address - Country:US
Mailing Address - Phone:484-459-2363
Mailing Address - Fax:
Practice Address - Street 1:455 WOODVIEW RD
Practice Address - Street 2:
Practice Address - City:WEST GROVE
Practice Address - State:PA
Practice Address - Zip Code:19390-9303
Practice Address - Country:US
Practice Address - Phone:610-431-5000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-03
Last Update Date:2023-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS022563207Q00000X, 207Q00000X
PAOT019960390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program