Provider Demographics
NPI:1942542394
Name:SCRUGGS, BROOKE DANIELLE (PA-C)
Entity type:Individual
Prefix:MS
First Name:BROOKE
Middle Name:DANIELLE
Last Name:SCRUGGS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:35 SHERWIN DR
Mailing Address - Street 2:
Mailing Address - City:TONAWANDA
Mailing Address - State:NY
Mailing Address - Zip Code:14150
Mailing Address - Country:US
Mailing Address - Phone:443-739-6316
Mailing Address - Fax:
Practice Address - Street 1:3245 SOUTHWESTERN BLVD.
Practice Address - Street 2:
Practice Address - City:ORCHARD PARK
Practice Address - State:NY
Practice Address - Zip Code:14127-1241
Practice Address - Country:US
Practice Address - Phone:716-699-9032
Practice Address - Fax:716-699-9035
Is Sole Proprietor?:No
Enumeration Date:2013-03-25
Last Update Date:2020-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDC0005011363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant