MEDICARE: SYREETA SCRUGGS

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	172V00000X	Community Health Worker
2	101YA0400X	Addiction (Substance Use Disorder) Counselor	195014	OH

General Provider Information

NPI Number	:	1326999004
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SYREETA SCRUGGS

Provider Business Mailing Address
First Line	:	2826 OXFORD AVE
Second Line	:
City	:	DAYTON
State	:	OH
Zip	:	45406-4338
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2826 OXFORD AVE
Second Line	:
City	:	DAYTON
State	:	OH
Zip	:	45406-4338
Country	:	US
Telephone Number	:	937-287-9942
Fax Number	:

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

Provider Enumeration Date	:	02/07/2026
Last Update Date	:	02/07/2026

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