Healthcare Provider Details

I. General information

NPI: 1427422682
Provider Name (Legal Business Name): ELIZABETH SKLAR PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/25/2015
Last Update Date: 11/15/2023
Certification Date: 11/15/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 BIRNIE AVE STE 201
SPRINGFIELD MA
01107-1107
US

IV. Provider business mailing address

300 BIRNIE AVE STE 201
SPRINGFIELD MA
01107-1107
US

V. Phone/Fax

Practice location:
  • Phone: 413-785-4666
  • Fax: 413-846-4742
Mailing address:
  • Phone: 413-785-4666
  • Fax: 413-846-4742

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License NumberPA5621
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: