Provider Demographics
NPI:1841987328
Name:SIRAGUSA, ALYSON M (PA-C)
Entity type:Individual
Prefix:
First Name:ALYSON
Middle Name:M
Last Name:SIRAGUSA
Suffix:
Gender:F
Credentials: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:PO BOX 14890
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12212-4890
Mailing Address - Country:US
Mailing Address - Phone:518-525-5634
Mailing Address - Fax:
Practice Address - Street 1:407 ALBANY SHAKER RD STE 100
Practice Address - Street 2:
Practice Address - City:LOUDONVILLE
Practice Address - State:NY
Practice Address - Zip Code:12211-1962
Practice Address - Country:US
Practice Address - Phone:518-435-1300
Practice Address - Fax:518-435-1397
Is Sole Proprietor?:No
Enumeration Date:2023-04-24
Last Update Date:2024-05-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY030690363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant