Healthcare Provider Details

I. General information

NPI: 1871254102
Provider Name (Legal Business Name): BRIANNA MCGRAW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/08/2022
Last Update Date: 06/13/2022
Certification Date: 06/13/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4900 BROAD RD
SYRACUSE NY
13215-2265
US

IV. Provider business mailing address

204 WOODLAND RD
SYRACUSE NY
13219-2252
US

V. Phone/Fax

Practice location:
  • Phone: 315-492-5634
  • Fax:
Mailing address:
  • Phone: 315-399-3228
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License Number33786
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number404157
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: