Provider Demographics
NPI:1700522471
Name:SADE, SKYLAR ROSE (PA)
Entity Type:Individual
Prefix:
First Name:SKYLAR
Middle Name:ROSE
Last Name:SADE
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:203 E 4TH AVE
Mailing Address - Street 2:
Mailing Address - City:RANSON
Mailing Address - State:WV
Mailing Address - Zip Code:25438-1617
Mailing Address - Country:US
Mailing Address - Phone:304-725-6343
Mailing Address - Fax:
Practice Address - Street 1:203 E 4TH AVE
Practice Address - Street 2:
Practice Address - City:RANSON
Practice Address - State:WV
Practice Address - Zip Code:25438-1617
Practice Address - Country:US
Practice Address - Phone:304-725-6343
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-06
Last Update Date:2022-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program