Healthcare Provider Details

I. General information

NPI: 1245881382
Provider Name (Legal Business Name): CARYLANN DAVIDSON BROWN RPA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CARYLANN HEDDERMAN GEDDES

II. Dates (important events)

Enumeration Date: 09/20/2019
Last Update Date: 01/09/2025
Certification Date: 01/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

315 S MANNING BLVD
ALBANY NY
12208-1707
US

IV. Provider business mailing address

PO BOX 14890
ALBANY NY
12212-4890
US

V. Phone/Fax

Practice location:
  • Phone: 518-525-8600
  • Fax: 518-525-6545
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number024138
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: