Healthcare Provider Details

I. General information

NPI: 1942804547
Provider Name (Legal Business Name): BRENNA M WHEELOCK PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: BRENNA EISENBERG

II. Dates (important events)

Enumeration Date: 11/24/2020
Last Update Date: 06/02/2026
Certification Date: 06/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7000 COLLAMER RD
EAST SYRACUSE NY
13057-9764
US

IV. Provider business mailing address

251 SALINA MEADOWS PARKWAY SUITE 100
SYRACUSE NY
13212
US

V. Phone/Fax

Practice location:
  • Phone: 315-656-7218
  • Fax:
Mailing address:
  • Phone: 315-464-2000
  • Fax: 315-464-2010

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number026062-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: