Healthcare Provider Details

I. General information

NPI: 1912830548
Provider Name (Legal Business Name): SKYLAR KATHERINE KLEESS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/04/2026
Last Update Date: 06/04/2026
Certification Date: 06/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

35 LONGWOOD RD
MIDDLE ISLAND NY
11953-2045
US

IV. Provider business mailing address

21225 15TH AVE
BAYSIDE NY
11360-1105
US

V. Phone/Fax

Practice location:
  • Phone: 347-626-9708
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number131110-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: