Healthcare Provider Details

I. General information

NPI: 1336923259
Provider Name (Legal Business Name): SKYLAR MOORE MS, CNS CANDIDATE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/22/2023
Last Update Date: 08/22/2023
Certification Date: 08/22/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

703 WASHINGTON AVE APT 211
TOWSON MD
21204-3929
US

IV. Provider business mailing address

703 WASHINGTON AVE APT 211
TOWSON MD
21204-3929
US

V. Phone/Fax

Practice location:
  • Phone: 410-456-0163
  • Fax:
Mailing address:
  • Phone: 410-456-0163
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133NN1002X
TaxonomyNutrition Education Nutritionist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code133N00000X
TaxonomyNutritionist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: