Healthcare Provider Details

I. General information

NPI: 1629030978
Provider Name (Legal Business Name): DAWN M SCOTT RPA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/03/2006
Last Update Date: 10/06/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4117 MEDICAL CENTER DR POD C
FAYETTEVILLE NY
13066-6600
US

IV. Provider business mailing address

4117 MEDICAL CENTER DR POD C
FAYETTEVILLE NY
13066-6600
US

V. Phone/Fax

Practice location:
  • Phone: 315-329-4968
  • Fax: 315-329-4969
Mailing address:
  • Phone: 315-329-4968
  • Fax: 315-329-4969

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number006103
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: