Individual
DANIELLE TYLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
121 EVERETT RD, ALBANY, NY 12205-1474
(518) 489-2663
Mailing address
121 EVERETT RD, ALBANY, NY 12205-1474
(518) 489-2663
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
030185
NY
363A00000X
Physician Assistant
—
—
363AS0400X
Surgical Physician Assistant
Primary
030185
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
07810268
—
NY
Enumeration date
06/26/2023
Last updated
07/24/2025
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