Individual
COURTNEY LEE EGGLESTON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
739 IRVING AVE, SUITE 500, SYRACUSE, NY 13210-1651
(315) 470-7409
(315) 475-2357
Mailing address
1001 W FAYETTE ST, SUITE 400, SYRACUSE, NY 13204-2859
(315) 470-7409
(315) 475-2357
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
012856
NY
363A00000X
Physician Assistant
MA055386
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
03061929
—
NY
Enumeration date
10/06/2008
Last updated
05/02/2016
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