Healthcare Provider Details

I. General information

NPI: 1013847714
Provider Name (Legal Business Name): SKYLAR GOLDSTEIN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/22/2026
Last Update Date: 05/28/2026
Certification Date: 05/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2394 SANDERS PL
BLOOMFIELD HILLS MI
48302-0457
US

IV. Provider business mailing address

2394 SANDERS PL
BLOOMFIELD HILLS MI
48302-0457
US

V. Phone/Fax

Practice location:
  • Phone: 248-860-9150
  • Fax:
Mailing address:
  • Phone: 248-860-9150
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number5601014048
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: