Healthcare Provider Details

I. General information

NPI: 1598730996
Provider Name (Legal Business Name): MEGHAN CANEDY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/20/2006
Last Update Date: 05/15/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

64 ROBBINS ST
WATERBURY CT
06708
US

IV. Provider business mailing address

282 WASHINGTON ST
HARTFORD CT
06106-3322
US

V. Phone/Fax

Practice location:
  • Phone: 203-573-6232
  • Fax: 203-573-6030
Mailing address:
  • Phone: 860-545-9200
  • Fax: 860-545-9134

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number063832
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: