Basic Information
| Provider Information | |||||||||
| NPI: | 1942542394 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SCRUGGS | ||||||||
| FirstName: | BROOKE | ||||||||
| MiddleName: | DANIELLE | ||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | PA-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 35 SHERWIN DR | ||||||||
| Address2: | |||||||||
| City: | TONAWANDA | ||||||||
| State: | NY | ||||||||
| PostalCode: | 14150 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4437396316 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 3245 SOUTHWESTERN BLVD. | ||||||||
| Address2: | |||||||||
| City: | ORCHARD PARK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 141271241 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7166999032 | ||||||||
| FaxNumber: | 7166999035 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/25/2013 | ||||||||
| LastUpdateDate: | 09/18/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 09/18/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | C0005011 | MD | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
No ID Information.