Healthcare Provider Details

I. General information

NPI: 1811984107
Provider Name (Legal Business Name): DAVID WAYNE SPRAGUE PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/01/2005
Last Update Date: 12/05/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12 ADAMS ST
BATAVIA NY
14020-2902
US

IV. Provider business mailing address

PO BOX 527
BATAVIA NY
14021-0527
US

V. Phone/Fax

Practice location:
  • Phone: 585-356-1323
  • Fax: 585-344-8649
Mailing address:
  • Phone: 585-356-1323
  • Fax: 585-344-8649

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number010122-2
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number010122-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: