Provider Demographics
NPI:1598546368
Name:HAUPTLI, ALLYSON (PA)
Entity type:Individual
Prefix:
First Name:ALLYSON
Middle Name:
Last Name:HAUPTLI
Suffix:
Gender:
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 E GENESEE ST STE 403
Mailing Address - Street 2:
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13210-1840
Mailing Address - Country:US
Mailing Address - Phone:315-464-2929
Mailing Address - Fax:315-464-2930
Practice Address - Street 1:1000 E GENESEE ST STE 403
Practice Address - Street 2:
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13210-1840
Practice Address - Country:US
Practice Address - Phone:315-464-2929
Practice Address - Fax:315-464-2930
Is Sole Proprietor?:No
Enumeration Date:2023-10-09
Last Update Date:2025-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY030806363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical