Provider Demographics
NPI:1356607857
Name:SEXTON, TYLER DEAN (MD)
Entity type:Individual
Prefix:DR
First Name:TYLER
Middle Name:DEAN
Last Name:SEXTON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:612 CORPORATE WAY STE 2M
Mailing Address - Street 2:
Mailing Address - City:VALLEY COTTAGE
Mailing Address - State:NY
Mailing Address - Zip Code:10989-2027
Mailing Address - Country:US
Mailing Address - Phone:877-258-6331
Mailing Address - Fax:718-414-1651
Practice Address - Street 1:1698 W HIBISCUS BLVD
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32901-2639
Practice Address - Country:US
Practice Address - Phone:727-515-7379
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-04-09
Last Update Date:2024-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME120700208000000X, 2083P0011X
ALMD.34368208000000X, 2083P0011X
MS23923208000000X, 2083P0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083P0011XAllopathic & Osteopathic PhysiciansPreventive MedicineUndersea and Hyperbaric Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics