Provider Demographics
NPI:1255319489
Name:STAGGERS-DEBERNY, JOY ANN
Entity Type:Individual
Prefix:MRS
First Name:JOY
Middle Name:ANN
Last Name:STAGGERS-DEBERNY
Suffix:
Gender:F
Credentials:
Other - Prefix:DR
Other - First Name:JOY
Other - Middle Name:ANN
Other - Last Name:STAGGERS-DEBERNY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:5470 TONAWANDA CREEK RD
Mailing Address - Street 2:ALL CORRESPONDENCE TO ABOVE ADDRESS
Mailing Address - City:NORTH TONAWANDA
Mailing Address - State:NY
Mailing Address - Zip Code:14120-9540
Mailing Address - Country:US
Mailing Address - Phone:716-625-0050
Mailing Address - Fax:716-625-6701
Practice Address - Street 1:3980 SHERIDAN DR
Practice Address - Street 2:SUTIE 401
Practice Address - City:AMHERST
Practice Address - State:NY
Practice Address - Zip Code:14226-1727
Practice Address - Country:US
Practice Address - Phone:716-625-0050
Practice Address - Fax:716-625-6701
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-06
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY190590174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01561417Medicaid
NYG15773Medicare UPIN
NY11739BMedicare ID - Type Unspecified