Provider Demographics
NPI:1215503362
Name:HARASTA, TYLER K (MD)
Entity type:Individual
Prefix:
First Name:TYLER
Middle Name:K
Last Name:HARASTA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:527 BAY MEADOW DR
Mailing Address - Street 2:
Mailing Address - City:WEBSTER
Mailing Address - State:NY
Mailing Address - Zip Code:14580-4001
Mailing Address - Country:US
Mailing Address - Phone:585-690-0778
Mailing Address - Fax:
Practice Address - Street 1:527 BAY MEADOW DR
Practice Address - Street 2:
Practice Address - City:WEBSTER
Practice Address - State:NY
Practice Address - Zip Code:14580-4001
Practice Address - Country:US
Practice Address - Phone:585-690-0778
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-31
Last Update Date:2021-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program