MEDICARE: BRENDA M STOUT PA-C

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	005069	NY
2	363AM0700X	Medical Physician Assistant	005069	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	:	1992773840
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRENDA M STOUT PA-C

Provider Business Mailing Address
First Line	:	100 KINGS HWY S
Second Line	:
City	:	ROCHESTER
State	:	NY
Zip	:	14617-5504
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	6668 FOURTH SECTION RD
Second Line	:
City	:	BROCKPORT
State	:	NY
Zip	:	14420-2448
Country	:	US
Telephone Number	:	585-368-6870
Fax Number	:	585-368-6871

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

Provider Enumeration Date	:	03/08/2006
Last Update Date	:	02/05/2026

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Directions to “ BRENDA M STOUT PA-C” Practice Location

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