Healthcare Provider Details

I. General information

NPI: 1699268391
Provider Name (Legal Business Name): MEGAN BIGELOW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MEGAN SHORTLAND

II. Dates (important events)

Enumeration Date: 06/07/2018
Last Update Date: 09/16/2026
Certification Date: 09/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 ROLAND WAY
OAKLAND CA
94621-2034
US

IV. Provider business mailing address

15200 FOOTHILL BLVD
CASTRO VALLEY CA
94578-1013
US

V. Phone/Fax

Practice location:
  • Phone: 510-839-3800
  • Fax:
Mailing address:
  • Phone: 510-352-9690
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number120066
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: