Kaylin Shaye Pelotenia, PMHNP-BC

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

License

407454 Issued in NY

Practice address

719 Harrison St
Syracuse, NY 13210-2695

Phone

(315) 464-3265

Fax

(315) 464-3282

NPI assigned

Aug 4, 2025

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in NY

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Nurse Practitioner

Education

Other, 2025

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Psychiatry Faculty Practice, IncGroup PAC ID 9234458530, 90 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: kpelotenia171520@direct.upstate.edu

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Psychiatry Faculty Practice, Inc.

  • Psychiatry Physician
  • Syracuse, NY
  • NPI 1881084820
  Medicare reassignment Care Compare group NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1754265600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1756080000000",
    "number": "1255215141",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "719 HARRISON ST",
            "city": "SYRACUSE",
            "state": "NY",
            "postal_code": "132102695",
            "telephone_number": "315-464-3265",
            "fax_number": "315-464-3282"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "719 HARRISON ST",
            "city": "SYRACUSE",
            "state": "NY",
            "postal_code": "132102695",
            "telephone_number": "315-464-3265",
            "fax_number": "315-464-3282"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PELOTENIA",
        "first_name": "KAYLIN",
        "middle_name": "SHAYE",
        "credential": "PMHNP-BC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2025-08-04",
        "last_updated": "2025-08-25",
        "certification_date": "2025-08-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "NY",
            "license": "407454",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Chase Coleman Pellett, MD
• Tanya Pellettiere, PHD
• Diane F Pelligra, RN
• Patricia Pelligrini, RN
• Anthony Richard Pelose, R.PH.
• Gayatri Pemmasani, MD
• Lindsay Marie Pendergast, M.S., CCC-SLP/LIC.
• Lillian Martina Penix, NP
• Penn Traffic Company the
• Penn Traffic Company, the

• Psychiatric/Mental Health Nurse Practitioner in Syracuse, NY
• Providers in Syracuse, NY by specialty
• Psychiatric/Mental Health Nurse Practitioner in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 25, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.