Tanya Pellettiere, PHD

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

015070-1 Issued in NY

Practice address

4317 E Genesee St Ste 205
Syracuse, NY 13214-2200

Phone

(315) 430-8040

NPI assigned

Oct 25, 2006

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in VA, NY2 enrollments

Eligible to order & refer

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

Green means eligible to order or refer.

Enrollment records 2

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: tanya.pellettiere.p1@direct.liberty-resources.nextgenshare.com

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.

• Suny Health Science Center at Syracuse

  • General Acute Care Hospital
  • Syracuse, NY
  • NPI 1184974529
  Medicare reassignment NPD
• Thrive Counseling LLC

  • Mental Health Counselor
  • Lynchburg, VA
  • NPI 1215181300
  Medicare reassignment NPD
• Suny Health Science Center at Syracuse

  • Pharmacy
  • Syracuse, NY
  • NPI 1306567474
  NPD
• Liberty Resources, Inc.

  • Primary Care Clinic/Center
  • Syracuse, NY
  • NPI 1821485483
  NPD (past)

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

{
    "created_epoch": "1161734400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1578355200000",
    "number": "1336223387",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4317 E GENESEE ST STE 205",
            "city": "SYRACUSE",
            "state": "NY",
            "postal_code": "132142200",
            "telephone_number": "315-430-8040"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4317 E GENESEE ST STE 205",
            "city": "SYRACUSE",
            "state": "NY",
            "postal_code": "132142200",
            "telephone_number": "315-430-8040"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PELLETTIERE",
        "first_name": "TANYA",
        "credential": "PHD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-10-25",
        "last_updated": "2020-01-07",
        "certification_date": "2020-01-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "NY",
            "license": "015070-1",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "02332456",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Alison Pelkonen
• Joan Elizabeth Pellegrino, MD
• Louis Pellegrino, MD
• Alexandra Francess Pelletier
• Chase Coleman Pellett, MD
• Diane F Pelligra, RN
• Patricia Pelligrini, RN
• Anthony Richard Pelose, R.PH.
• Kaylin Shaye Pelotenia, PMHNP-BC
• Gayatri Pemmasani, MD

• Clinical Psychologist in Syracuse, NY
• Providers in Syracuse, NY by specialty
• Clinical Psychologist in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 7, 2020; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.