Provider Demographics
NPI:1184462061
Name:TYSEN, SHRIYANI TAYLOR (DNP, PNP-PC)
Entity type:Individual
Prefix:
First Name:SHRIYANI
Middle Name:TAYLOR
Last Name:TYSEN
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Gender:
Credentials:DNP, PNP-PC
Other - Prefix:
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Mailing Address - Street 1:PO BOX 778912
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60677-8912
Mailing Address - Country:US
Mailing Address - Phone:317-777-6435
Mailing Address - Fax:317-777-6644
Practice Address - Street 1:621 MEMORIAL DR STE 612
Practice Address - Street 2:
Practice Address - City:SOUTH BEND
Practice Address - State:IN
Practice Address - Zip Code:46601-1085
Practice Address - Country:US
Practice Address - Phone:574-232-3325
Practice Address - Fax:574-232-3358
Is Sole Proprietor?:No
Enumeration Date:2024-07-16
Last Update Date:2025-04-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IN71015594A363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics