Provider Demographics
NPI:1649490954
Name:SACAY LARSON, SKY LEE (LMT)
Entity type:Individual
Prefix:MRS
First Name:SKY
Middle Name:LEE
Last Name:SACAY LARSON
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2346
Mailing Address - Street 2:
Mailing Address - City:KEALAKEKUA
Mailing Address - State:HI
Mailing Address - Zip Code:96750-2346
Mailing Address - Country:US
Mailing Address - Phone:808-936-2252
Mailing Address - Fax:808-322-0694
Practice Address - Street 1:79-7452 A MAMALAHOA HWY.
Practice Address - Street 2:
Practice Address - City:KEALAKEKUA
Practice Address - State:HI
Practice Address - Zip Code:96750-2346
Practice Address - Country:US
Practice Address - Phone:808-936-2252
Practice Address - Fax:808-322-0694
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI9270174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist