Healthcare Provider Details

I. General information

NPI: 1053006841
Provider Name (Legal Business Name): TAYMI HERNANDEZ RODRIGUEZ MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/07/2023
Last Update Date: 07/17/2026
Certification Date: 07/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

750 E ADAMS ST
SYRACUSE NY
13210-1834
US

IV. Provider business mailing address

750 EAST ADAMS ST
SYRACUSE NY
13210-2306
US

V. Phone/Fax

Practice location:
  • Phone: 315-464-4363
  • Fax: 315-464-4854
Mailing address:
  • Phone: 315-464-4363
  • Fax: 315-464-4854

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number345546
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: