Healthcare Provider Details

I. General information

NPI: 1972425817
Provider Name (Legal Business Name): AVA ROSEMARIE BRAZIE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/29/2026
Last Update Date: 07/29/2026
Certification Date: 07/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

742 JAMES ST
SYRACUSE NY
13203-2017
US

IV. Provider business mailing address

5243 WINTERTON DR
FAYETTEVILLE NY
13066-1762
US

V. Phone/Fax

Practice location:
  • Phone: 315-703-2700
  • Fax:
Mailing address:
  • Phone: 315-663-8738
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: