Healthcare Provider Details

I. General information

NPI: 1487476776
Provider Name (Legal Business Name): SKYLUAR WINGFIELD LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/28/2024
Last Update Date: 10/06/2026
Certification Date: 10/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5311 NORTHFIELD RD STE 205
BEDFORD OH
44146-1135
US

IV. Provider business mailing address

5004 TURNEY RD
GARFIELD HEIGHTS OH
44125-2503
US

V. Phone/Fax

Practice location:
  • Phone: 216-780-1057
  • Fax:
Mailing address:
  • Phone: 216-429-9700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number33.025272
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: