Provider Demographics
NPI:1548885874
Name:POLAND, SKYLAR TATE (AUD)
Entity type:Individual
Prefix:
First Name:SKYLAR
Middle Name:TATE
Last Name:POLAND
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 GILCHRIST CT
Mailing Address - Street 2:
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23320-3285
Mailing Address - Country:US
Mailing Address - Phone:757-646-2965
Mailing Address - Fax:
Practice Address - Street 1:1577 WILROY RD STE 201
Practice Address - Street 2:
Practice Address - City:SUFFOLK
Practice Address - State:VA
Practice Address - Zip Code:23434-2432
Practice Address - Country:US
Practice Address - Phone:757-934-8797
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-12
Last Update Date:2021-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2201001774231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist