Healthcare Provider Details

I. General information

NPI: 1750891081
Provider Name (Legal Business Name): MRS. HEATHER SKINNER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/29/2017
Last Update Date: 03/28/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

75 CRYSTAL RUN RD SUITE 201
MIDDLETOWN NY
10941
US

IV. Provider business mailing address

75 CRYSTAL RUN RD SUITE 201
MIDDLETOWN NY
10941
US

V. Phone/Fax

Practice location:
  • Phone: 845-692-4391
  • Fax:
Mailing address:
  • Phone: 845-692-4391
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: