Provider Demographics
NPI:1750160925
Name:SKY INFUSIONS AND MEDSPA, LLC
Entity type:Organization
Organization Name:SKY INFUSIONS AND MEDSPA, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:NP
Authorized Official - Prefix:
Authorized Official - First Name:LORITA
Authorized Official - Middle Name:NKECHI
Authorized Official - Last Name:NNAKA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-456-4143
Mailing Address - Street 1:10713 CASTLETON TURN
Mailing Address - Street 2:
Mailing Address - City:UPPER MARLBORO
Mailing Address - State:MD
Mailing Address - Zip Code:20774-1449
Mailing Address - Country:US
Mailing Address - Phone:301-456-4143
Mailing Address - Fax:
Practice Address - Street 1:1300 MERCANTILE LN STE 129-9
Practice Address - Street 2:
Practice Address - City:LARGO
Practice Address - State:MD
Practice Address - Zip Code:20774-5327
Practice Address - Country:US
Practice Address - Phone:301-291-5957
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SKY INFUSIONS AND MEDSPA, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-09-26
Last Update Date:2023-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult HealthGroup - Multi-Specialty