Healthcare Provider Details

I. General information

NPI: 1053227736
Provider Name (Legal Business Name): TINA MARIE DASHNO CRPA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/21/2026
Last Update Date: 08/21/2026
Certification Date: 08/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3606 JAMES ST
SYRACUSE NY
13206-2448
US

IV. Provider business mailing address

3606 JAMES ST
SYRACUSE NY
13206-2448
US

V. Phone/Fax

Practice location:
  • Phone: 315-680-3584
  • Fax:
Mailing address:
  • Phone: 315-680-3584
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License NumberCRPA-P-9762
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: