Provider Demographics
NPI:1922417963
Name:SKIATHITIS, MICHAEL (BA)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:SKIATHITIS
Suffix:
Gender:M
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2550 ALDEN TRACE BLVD W
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32246-9799
Mailing Address - Country:US
Mailing Address - Phone:904-352-5766
Mailing Address - Fax:904-646-5588
Practice Address - Street 1:2550 ALDEN TRACE BLVD W
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32246-9799
Practice Address - Country:US
Practice Address - Phone:904-352-5766
Practice Address - Fax:904-646-5588
Is Sole Proprietor?:No
Enumeration Date:2014-08-04
Last Update Date:2014-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker