Provider Demographics
NPI:1831073360
Name:BERRY, SKYLAR TYLER
Entity type:Individual
Prefix:
First Name:SKYLAR
Middle Name:TYLER
Last Name:BERRY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3001 E TAHQUITZ CANYON WAY
Mailing Address - Street 2:ST. 103/104
Mailing Address - City:PALM DESERT
Mailing Address - State:CA
Mailing Address - Zip Code:92260
Mailing Address - Country:US
Mailing Address - Phone:442-371-3342
Mailing Address - Fax:
Practice Address - Street 1:3001 E TAHQUITZ CANYON WAY
Practice Address - Street 2:ST. 103/104
Practice Address - City:PALM SPRINGS
Practice Address - State:CA
Practice Address - Zip Code:92262
Practice Address - Country:US
Practice Address - Phone:442-371-3342
Practice Address - Fax:442-371-3342
Is Sole Proprietor?:No
Enumeration Date:2025-08-05
Last Update Date:2025-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker