Healthcare Provider Details

I. General information

NPI: 1831627462
Provider Name (Legal Business Name): SKY ORTHOTICS & PROSTHETICS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/26/2017
Last Update Date: 07/21/2022
Certification Date: 01/27/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1009 MAITLAND CENTER COMMONS BLVD STE 207
MAITLAND FL
32751-7270
US

IV. Provider business mailing address

1009 MAITLAND CENTER COMMONS BLVD STE 207
MAITLAND FL
32751-7270
US

V. Phone/Fax

Practice location:
  • Phone: 844-759-5462
  • Fax: 888-653-3429
Mailing address:
  • Phone: 844-759-5462
  • Fax: 888-653-3429

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number State

VIII. Authorized Official

Name: MICHAEL NEWMYER
Title or Position: C0O
Credential:
Phone: 407-362-7944