Healthcare Provider Details

I. General information

NPI: 1598546368
Provider Name (Legal Business Name): ALLYSON HAUPTLI PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/09/2023
Last Update Date: 04/23/2025
Certification Date: 04/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 E GENESEE ST STE 403
SYRACUSE NY
13210-1840
US

IV. Provider business mailing address

1000 E GENESEE ST STE 403
SYRACUSE NY
13210-1840
US

V. Phone/Fax

Practice location:
  • Phone: 315-464-2929
  • Fax: 315-464-2930
Mailing address:
  • Phone: 315-464-2929
  • Fax: 315-464-2930

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number030806
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: