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General NPI Number Information
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NPI Number | 1598392979
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Entity Type | Individual
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Provider Name | MICHAELA SKYLAR BANKS
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Gender | Female
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Dates
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Enumeration Date | 03/25/2020
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Last Update Date | 02/11/2026
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Provider Practice Location Address
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Address Line | 235 N PEARL ST
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City | BROCKTON
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State | MA
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Zip | 02301-1794
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Country | US
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Telephone | 508-427-3000
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Fax |
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Provider Business Mailing Address
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Address Line | 960 MASSACHUSETTS AVE STE 2
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City | BOSTON
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State | MA
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Zip | 02118-2690
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Country | US
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Telephone | 617-414-4505
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | 331611
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License Number State | LA
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Taxonomy #2
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | 334087
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License Number State | NY
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Taxonomy #3
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | 1025185
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License Number State | MA
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Taxonomy #4
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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