NPI 1184147142

Michael Todd Tyson

Practitioner Driver Rochester, NY

Practice location

Address: 696 Woodbine Ave, Rochester, NY 14619-2030
Phone: (585) 532-0636

Registered specialties

Driver Primary

Other Service Providers Taxonomy 172A00000X Licence 760970342 (NY)

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Registry record

NPI: 1184147142
Entity type: Individual
Sex (as registered): Male
NPI issued: 21 Jul 2017
Record last updated: 21 Jul 2022

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.