Healthcare Provider Details

I. General information

NPI: 1386568764
Provider Name (Legal Business Name): TIFFANY M MATTHEWS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/07/2026
Last Update Date: 09/22/2026
Certification Date: 09/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1729 BURRSTONE RD
NEW HARTFORD NY
13413-1001
US

IV. Provider business mailing address

1729 BURRSTONE RD
NEW HARTFORD NY
13413-1001
US

V. Phone/Fax

Practice location:
  • Phone: 315-798-1527
  • Fax: 315-798-1589
Mailing address:
  • Phone: 315-798-1702
  • Fax: 315-798-1726

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number631059
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: