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NPI Code Detail

MEDICARE: TYLER SHANE BUCHANAN

MEDICARE: TYLER SHANE BUCHANAN
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1106S00000XBehavior Technician

General Provider Information

NPI Number : 1164245429
Entity Type Code : Individual
Provider Name (Legal Business Name) : TYLER SHANE BUCHANAN
Provider Business Mailing Address
First Line : 245 BRIARGATE RD APT J40
Second Line :
City : MANKATO
State : MN
Zip : 56001-5050
Country : US
Telephone Number : 608-207-0651
Fax Number :
Provider Business Practice Location Address
First Line : 1701 ADAMS ST
Second Line :
City : MANKATO
State : MN
Zip : 56001-4895
Country : US
Telephone Number : 507-565-0150
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/05/2024
Last Update Date : 03/31/2026

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Directions to “ TYLER SHANE BUCHANAN ” Practice Location

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