Healthcare Provider Details

I. General information

NPI: 1679487714
Provider Name (Legal Business Name): TYLER PROULX PRSS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: FABLE BELLAMY HAWTHORNE PRSS

II. Dates (important events)

Enumeration Date: 09/28/2026
Last Update Date: 09/28/2026
Certification Date: 09/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

79 COURT ST
MIDDLEBURY VT
05753-1406
US

IV. Provider business mailing address

351 LINDALE CIR
MIDDLEBURY VT
05753-8562
US

V. Phone/Fax

Practice location:
  • Phone: 802-388-4249
  • Fax:
Mailing address:
  • Phone: 802-825-5060
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: