Provider Demographics
NPI:1457147753
Name:TYNAN, SKYLAR ANNE (MS, RD)
Entity type:Individual
Prefix:
First Name:SKYLAR
Middle Name:ANNE
Last Name:TYNAN
Suffix:
Gender:F
Credentials:MS, RD
Other - Prefix:
Other - First Name:SKYLAR
Other - Middle Name:
Other - Last Name:SCHAAF
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3980 S HOLGUIN WAY
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85248-4533
Mailing Address - Country:US
Mailing Address - Phone:714-981-5948
Mailing Address - Fax:
Practice Address - Street 1:9069 W THUNDERBIRD RD
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85381-4412
Practice Address - Country:US
Practice Address - Phone:714-981-5948
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-15
Last Update Date:2025-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ86325918133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered