MEDICARE: BRITNI DAUGHTRIDGE

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	363A00000X	Physician Assistant	018038	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	018038	OTHER	NY	NY LICENSE

General Provider Information

NPI Number	:	1336524982
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRITNI DAUGHTRIDGE

Provider Business Mailing Address
First Line	:	30 W 60TH ST APT 3U
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10023-7908
Country	:	US
Telephone Number	:	240-520-4018
Fax Number	:	646-665-3604

Provider Business Practice Location Address
First Line	:	30 W 60TH ST APT 3U
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10023-7908
Country	:	US
Telephone Number	:	240-520-4018
Fax Number	:	646-665-3604

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

Provider Enumeration Date	:	07/24/2015
Last Update Date	:	07/24/2015

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Directions to “ BRITNI DAUGHTRIDGE ” Practice Location

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