Healthcare Provider Details

I. General information

NPI: 1235343948
Provider Name (Legal Business Name): MEGHAN ELIZABETH FLYNN MSPT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/10/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 SHELBURNE RD
STAMFORD CT
06902-3628
US

IV. Provider business mailing address

120 STRAWBERRY HILL AVE APT. 216
STAMFORD CT
06902-2770
US

V. Phone/Fax

Practice location:
  • Phone: 203-276-2462
  • Fax:
Mailing address:
  • Phone: 732-693-4691
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License Number007639
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: