Brielle Dominique Bagozzi

Primary specialty

Athletic TrainerTaxonomy code 2255A2300X

License

004995 Issued in NY

Practice address

119 Lakewood Pines TRL
Syracuse, NY 13209-1161

Phone

(315) 447-7761

NPI assigned

Jul 25, 2022

Reactivated

Oct 6, 2025

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1658707200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1759708800000",
    "number": "1730815671",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "119 LAKEWOOD PINES TRL",
            "city": "SYRACUSE",
            "state": "NY",
            "postal_code": "132091161",
            "telephone_number": "315-447-7761"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "119 LAKEWOOD PINES TRL",
            "city": "SYRACUSE",
            "state": "NY",
            "postal_code": "132091161",
            "telephone_number": "315-447-7761"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BAGOZZI",
        "first_name": "BRIELLE",
        "middle_name": "DOMINIQUE",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2022-07-25",
        "last_updated": "2025-10-06",
        "certification_date": "2025-10-06",
        "deactivation_date": "2025-09-11",
        "reactivation_date": "2025-10-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2255A2300X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Athletic Trainer",
            "state": "NY",
            "license": "004995",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Filofteia Badila, DDS
• Maria Dussing Badman, PHARMD
• Dorgam Badran, M.D.
• Mark T. Baesl, MD
• Deborah M. Baez, LMSW
• Susan Bagozzi, LPN
• Fatmata Bah, MD
• Momodou Bah
• Erin E. Bahamonde, NP
• Serene Bahi, DO

• Athletic Trainer in Syracuse, NY
• Providers in Syracuse, NY by specialty
• Athletic Trainer in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 6, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.