Provider Demographics
NPI:1437450368
Name:DAGGETT, REBEKAH CLAIR (MSM, PA-C)
Entity Type:Individual
Prefix:
First Name:REBEKAH
Middle Name:CLAIR
Last Name:DAGGETT
Suffix:
Gender:F
Credentials:MSM, PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:230 7TH ST
Mailing Address - Street 2:APT #3
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11215-3208
Mailing Address - Country:US
Mailing Address - Phone:615-347-4626
Mailing Address - Fax:
Practice Address - Street 1:1825 EASTCHESTER RD
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10461-2301
Practice Address - Country:US
Practice Address - Phone:718-430-3204
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-09
Last Update Date:2013-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1885363A00000X
NY016244363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant