Provider Demographics
NPI:1730670019
Name:KOCHANEK, TARALYNN
Entity Type:Individual
Prefix:
First Name:TARALYNN
Middle Name:
Last Name:KOCHANEK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:HELIO HEALTH
Mailing Address - Street 2:375 WEST ORONDAGA ST
Mailing Address - City:SYRUCUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13202
Mailing Address - Country:US
Mailing Address - Phone:315-478-2453
Mailing Address - Fax:315-425-8917
Practice Address - Street 1:HELIO HEALTH
Practice Address - Street 2:375 WEST ORONDAGA ST
Practice Address - City:SYRUCUSE
Practice Address - State:NY
Practice Address - Zip Code:13202
Practice Address - Country:US
Practice Address - Phone:315-478-2453
Practice Address - Fax:315-425-8917
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-23
Last Update Date:2021-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY403055363LP0808X
NY343213363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily