Healthcare Provider Details

I. General information

NPI: 1215503362
Provider Name (Legal Business Name): TYLER K HARASTA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/31/2021
Last Update Date: 07/07/2026
Certification Date: 07/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

527 BAY MEADOW DR
WEBSTER NY
14580-4001
US

IV. Provider business mailing address

527 BAY MEADOW DR
WEBSTER NY
14580-4001
US

V. Phone/Fax

Practice location:
  • Phone: 585-690-0778
  • Fax:
Mailing address:
  • Phone: 585-690-0778
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberMD494949
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: