Provider Demographics
NPI:1336223221
Name:PRYOR, AURORA DAWN (MD)
Entity Type:Individual
Prefix:DR
First Name:AURORA
Middle Name:DAWN
Last Name:PRYOR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:HSC 18 040
Mailing Address - Street 2:STONY BROOK UNIVERSITY MEDICAL CENTER
Mailing Address - City:STONY BROOK
Mailing Address - State:NY
Mailing Address - Zip Code:11794-0001
Mailing Address - Country:US
Mailing Address - Phone:631-444-7298
Mailing Address - Fax:
Practice Address - Street 1:HSC 18 040
Practice Address - Street 2:STONY BROOK UNIVERSITY MEDICAL CENTER
Practice Address - City:STONY BROOK
Practice Address - State:NY
Practice Address - Zip Code:11794-0001
Practice Address - Country:US
Practice Address - Phone:631-444-7298
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-25
Last Update Date:2011-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC96-10203208600000X
NY262455-1208600000X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
H86110Medicare ID - Type Unspecified
NC2017491Medicare ID - Type Unspecified
NC891338UMedicare ID - Type Unspecified