MEDICARE: PAMELA DENISE SURRENCY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101Y00000X	Counselor

General Provider Information

NPI Number	:	1053985655
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PAMELA DENISE SURRENCY

Provider Business Mailing Address
First Line	:	2037 UTICA AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11234-3234
Country	:	US
Telephone Number	:	718-253-1366
Fax Number	:	718-758-5883

Provider Business Practice Location Address
First Line	:	2037 UTICA AVE STE 2
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11234-3234
Country	:	US
Telephone Number	:	718-253-1366
Fax Number	:	718-758-5683

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/18/2021
Last Update Date	:	05/18/2021

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Directions to “ PAMELA DENISE SURRENCY ” Practice Location

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