Healthcare Provider Details

I. General information

NPI: 1407343601
Provider Name (Legal Business Name): SKYLINE WOUND CARE PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/13/2018
Last Update Date: 10/16/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

80 MADDEX DR
SHEPHERDSTOWN WV
25443-4305
US

IV. Provider business mailing address

4470 BLACK IRONWOOD DR
FAIRFAX VA
22030-9068
US

V. Phone/Fax

Practice location:
  • Phone: 304-876-9422
  • Fax: 304-876-6869
Mailing address:
  • Phone: 443-803-6830
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0122X
TaxonomyPlastic and Reconstructive Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: AMANI HEMPHILL
Title or Position: OWNER
Credential: MD
Phone: 443-803-6830