Basic Information
| Provider Information | |||||||||
| NPI: | 1568901007 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | TEFFT | ||||||||
| FirstName: | CORISSA | ||||||||
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| Credential: | PA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1001 W FAYETTE ST STE 400 | ||||||||
| Address2: | |||||||||
| City: | SYRACUSE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 132042866 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3159373433 | ||||||||
| FaxNumber: | 3156820570 | ||||||||
| Practice Location | |||||||||
| Address1: | 4500 PEWTER LN BLDG 1 | ||||||||
| Address2: | |||||||||
| City: | MANLIUS | ||||||||
| State: | NY | ||||||||
| PostalCode: | 131047704 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3156826600 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/16/2017 | ||||||||
| LastUpdateDate: | 03/11/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 03/11/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
No ID Information.