Provider Demographics
NPI:1710567730
Name:PENTASUGLIA, SKYLAR DANE (AUD)
Entity type:Individual
Prefix:DR
First Name:SKYLAR
Middle Name:DANE
Last Name:PENTASUGLIA
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 1:301 LOUIS ST STE 101
Mailing Address - Street 2:
Mailing Address - City:KINGSPORT
Mailing Address - State:TN
Mailing Address - Zip Code:37660-5195
Mailing Address - Country:US
Mailing Address - Phone:423-246-4600
Mailing Address - Fax:423-246-3311
Practice Address - Street 1:301 LOUIS ST STE 101
Practice Address - Street 2:
Practice Address - City:KINGSPORT
Practice Address - State:TN
Practice Address - Zip Code:37660-5195
Practice Address - Country:US
Practice Address - Phone:423-246-4600
Practice Address - Fax:423-246-3311
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-13
Last Update Date:2025-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
106S00000X
TN2310231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician