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General NPI Number Information
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NPI Number | 1457784647
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Entity Type | Individual
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Provider Name | BRYAN BURROUGHS NURSE PRACTIONER
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Gender | Male
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Dates
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Enumeration Date | 08/12/2013
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Last Update Date | 04/08/2025
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Provider Practice Location Address
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Address Line | 1200A SCOTTSVILLE RD STE 39
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City | ROCHESTER
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State | NY
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Zip | 14624-5703
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Country | US
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Telephone | 585-319-0785
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Fax |
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Provider Business Mailing Address
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Address Line | 28 HARVEST RIDGE TRL
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City | WEST HENRIETTA
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State | NY
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Zip | 14586-8920
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Country | US
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Telephone | 585-319-0785
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Fax | 585-287-6288
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | F4022251
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License Number State | NY
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