Provider Demographics
NPI:1790035236
Name:CORNELIUS, TARYN (RNC, IBCLC)
Entity type:Individual
Prefix:
First Name:TARYN
Middle Name:
Last Name:CORNELIUS
Suffix:
Gender:F
Credentials:RNC, IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 PROVOST DRIVE
Mailing Address - Street 2:
Mailing Address - City:SUFFERN
Mailing Address - State:NY
Mailing Address - Zip Code:10901-7540
Mailing Address - Country:US
Mailing Address - Phone:845-598-1356
Mailing Address - Fax:
Practice Address - Street 1:10 PROVOST DRIVE
Practice Address - Street 2:
Practice Address - City:SUFFERN
Practice Address - State:NY
Practice Address - Zip Code:10901-7540
Practice Address - Country:US
Practice Address - Phone:845-598-1356
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-12
Last Update Date:2012-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY108-30119174N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RN