Healthcare Provider Details

I. General information

NPI: 1396606257
Provider Name (Legal Business Name): TYLER PALMER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/20/2025
Last Update Date: 11/20/2025
Certification Date: 11/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1237 MAIN ST
BUFFALO NY
14209-2111
US

IV. Provider business mailing address

34 BURGARD PL
BUFFALO NY
14211-2424
US

V. Phone/Fax

Practice location:
  • Phone: 716-884-9101
  • Fax: 716-884-7703
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number985759
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: