Healthcare Provider Details

I. General information

NPI: 1679279467
Provider Name (Legal Business Name): ABIGAIL HUNT DUGO PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/02/2023
Last Update Date: 06/30/2026
Certification Date: 06/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 INTREPID LN STE 2
SYRACUSE NY
13205-2546
US

IV. Provider business mailing address

100 INTREPID LN STE 2
SYRACUSE NY
13205-2546
US

V. Phone/Fax

Practice location:
  • Phone: 315-637-9116
  • Fax: 315-637-0436
Mailing address:
  • Phone: 315-637-9116
  • Fax: 315-637-0436

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number031305
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: