Provider Demographics
NPI:1336751627
Name:GROSHANS, KYLE (PMHNP)
Entity Type:Individual
Prefix:
First Name:KYLE
Middle Name:
Last Name:GROSHANS
Suffix:
Gender:M
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:614 S SALINA ST STE 300
Mailing Address - Street 2:
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13202-3520
Mailing Address - Country:US
Mailing Address - Phone:315-425-0599
Mailing Address - Fax:
Practice Address - Street 1:614 S SALINA ST STE 300
Practice Address - Street 2:
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13202-3520
Practice Address - Country:US
Practice Address - Phone:315-425-0599
Practice Address - Fax:315-471-6760
Is Sole Proprietor?:No
Enumeration Date:2020-08-19
Last Update Date:2021-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY403120-01363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health