Provider Demographics
NPI:1013617323
Name:DELAURENTIS, TYLER
Entity Type:Individual
Prefix:
First Name:TYLER
Middle Name:
Last Name:DELAURENTIS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 W 5TH ST APT 6D
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02127-3351
Mailing Address - Country:US
Mailing Address - Phone:203-909-1892
Mailing Address - Fax:
Practice Address - Street 1:20 W 5TH ST APT 6D
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02127-3351
Practice Address - Country:US
Practice Address - Phone:203-909-1892
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-06
Last Update Date:2023-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program