MEDICARE: MRS. JOY ANN STAGGERS-DEBERNY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist	190590	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1255319489
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JOY ANN STAGGERS-DEBERNY

Provider Business Mailing Address
First Line	:	5470 TONAWANDA CREEK RD
Second Line	:	ALL CORRESPONDENCE TO ABOVE ADDRESS
City	:	NORTH TONAWANDA
State	:	NY
Zip	:	14120-9540
Country	:	US
Telephone Number	:	716-625-0050
Fax Number	:	716-625-6701

Provider Business Practice Location Address
First Line	:	3980 SHERIDAN DR
Second Line	:	SUTIE 401
City	:	AMHERST
State	:	NY
Zip	:	14226-1727
Country	:	US
Telephone Number	:	716-625-0050
Fax Number	:	716-625-6701

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/06/2006
Last Update Date	:	07/09/2007

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