Individual
TYLER GRANT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
RN
Contact information
Practice address
301 PROSPECT AVE, SYRACUSE, NY 13203-1807
(315) 448-5111
Mailing address
1305 WALT WHITMAN RD STE 300, MELVILLE, NY 11747-4300
(516) 945-3000
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
688131
NY
367500000X
Certified Registered Nurse Anesthetist
Primary
688131
NY
Other
Enumeration date
08/18/2022
Last updated
12/19/2023
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