Basic Information
| Provider Information | |||||||||
| NPI: | 1104534247 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SKYHIGH CHILDREN HEALTH LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1814 SW 28TH ST | ||||||||
| Address2: | |||||||||
| City: | OCALA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 344717726 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3522377646 | ||||||||
| FaxNumber: | 3522910361 | ||||||||
| Practice Location | |||||||||
| Address1: | 2801 SE 1ST AVE STE 102 | ||||||||
| Address2: | |||||||||
| City: | OCALA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 344710478 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3522377646 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 11/08/2022 | ||||||||
| LastUpdateDate: | 11/08/2022 | ||||||||
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| AuthorizedOfficialLastName: | ADEBIYI | ||||||||
| AuthorizedOfficialFirstName: | BOLANLE | ||||||||
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| AuthorizedOfficialTitleorPosition: | OWNER/DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 3522347646 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
| NPICertificationDate: | 11/08/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Pediatrics |
ID Information
| ID | Type | State | Issuer | Description | ME130997 | 01 | FL | MEDICAL LICENSE | OTHER |