Healthcare Provider Details

I. General information

NPI: 1861248023
Provider Name (Legal Business Name): SKYLER MADISON SULLIVAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/29/2024
Last Update Date: 08/10/2026
Certification Date: 08/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1343 N GRAND AVE STE 200
COVINA CA
91724-4043
US

IV. Provider business mailing address

2868 MAHAN DR UNIT 25
TALLAHASSEE FL
32308-5468
US

V. Phone/Fax

Practice location:
  • Phone: 833-227-3454
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-24-71632
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: