Healthcare Provider Details

I. General information

NPI: 1700522471
Provider Name (Legal Business Name): SKYLAR ROSE SADE PA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/06/2022
Last Update Date: 03/18/2025
Certification Date: 03/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

203 E 4TH AVE
RANSON WV
25438-1617
US

IV. Provider business mailing address

203 E 4TH AVE
RANSON WV
25438-1617
US

V. Phone/Fax

Practice location:
  • Phone: 304-725-6343
  • Fax:
Mailing address:
  • Phone: 304-725-6343
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number2654
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: