Provider Demographics
NPI:1912093568
Name:TISLER, CHERYL LYNN (MD)
Entity type:Individual
Prefix:DR
First Name:CHERYL
Middle Name:LYNN
Last Name:TISLER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:140 ALLEN'S CREEK RD
Mailing Address - Street 2:SUITE 04
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14618-3307
Mailing Address - Country:US
Mailing Address - Phone:585-394-6656
Mailing Address - Fax:585-301-4917
Practice Address - Street 1:140 ALLEN'S CREEK RD
Practice Address - Street 2:SUITE 04
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14618-3307
Practice Address - Country:US
Practice Address - Phone:585-394-6656
Practice Address - Fax:585-301-4917
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-04
Last Update Date:2022-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1802232084P0800X, 2084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
F85443Medicare UPIN
NYBB0748Medicare ID - Type Unspecified