Healthcare Provider Details

I. General information

NPI: 1174995658
Provider Name (Legal Business Name): MIDZY B LYSIUS NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/23/2015
Last Update Date: 12/10/2025
Certification Date: 12/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

725 EAST ADAMS STREET
SYRACUSE NY
13210
US

IV. Provider business mailing address

251 SALINA MEADOWS PARKWAY SUITE 100
SYRACUSE NY
13212
US

V. Phone/Fax

Practice location:
  • Phone: 315-464-4842
  • Fax: 315-464-8912
Mailing address:
  • Phone: 315-464-2000
  • Fax: 315-464-2010

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number343225
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number343225
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number685753-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: