Healthcare Provider Details

I. General information

NPI: 1093899486
Provider Name (Legal Business Name): JESSICA L MEGER MS, ATC, PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/24/2006
Last Update Date: 05/07/2021
Certification Date: 05/07/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1625 STRAITS TPKE SUITE #211
MIDDLEBURY CT
06762-1836
US

IV. Provider business mailing address

100 KINGS HWY S
ROCHESTER NY
14617-5504
US

V. Phone/Fax

Practice location:
  • Phone: 203-573-9512
  • Fax: 203-568-2904
Mailing address:
  • Phone: 585-723-7281
  • Fax: 585-723-7280

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number001281
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number002603
License Number StateCT
# 3
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number026563
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: