Healthcare Provider Details

I. General information

NPI: 1912093568
Provider Name (Legal Business Name): CHERYL LYNN TISLER M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/04/2006
Last Update Date: 11/04/2022
Certification Date: 11/04/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

140 ALLEN'S CREEK RD SUITE 04
ROCHESTER NY
14618-3307
US

IV. Provider business mailing address

140 ALLEN'S CREEK RD SUITE 04
ROCHESTER NY
14618-3307
US

V. Phone/Fax

Practice location:
  • Phone: 585-394-6656
  • Fax: 585-301-4917
Mailing address:
  • Phone: 585-394-6656
  • Fax: 585-301-4917

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number180223
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number180223
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: