Healthcare Provider Details

I. General information

NPI: 1861657934
Provider Name (Legal Business Name): SKYE SIMON NASHELSKY
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/28/2008
Last Update Date: 12/04/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1385 MISSION ST SUITE 240
SAN FRANCISCO CA
94103-2623
US

IV. Provider business mailing address

112 7TH ST UNIT C
SANTA ROSA CA
95401-6203
US

V. Phone/Fax

Practice location:
  • Phone: 415-864-4002
  • Fax: 415-864-7093
Mailing address:
  • Phone: 707-536-1502
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number89418
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: