Healthcare Provider Details

I. General information

NPI: 1710803101
Provider Name (Legal Business Name): MRS. ALANNA LAUREL TYO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/29/2026
Last Update Date: 06/29/2026
Certification Date: 06/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 HOSPITAL DR
MASSENA NY
13662-1019
US

IV. Provider business mailing address

137 HORTON RD
MASSENA NY
13662-3221
US

V. Phone/Fax

Practice location:
  • Phone: 315-769-3000
  • Fax:
Mailing address:
  • Phone: 315-769-3000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number2773298
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: