Healthcare Provider Details

I. General information

NPI: 1942727052
Provider Name (Legal Business Name): MEGHAN DESANCTIS MASTERS IN EDUCATION
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/29/2017
Last Update Date: 07/11/2022
Certification Date: 07/11/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 SE 19TH AVE
POMPANO BEACH FL
33060-7543
US

IV. Provider business mailing address

720 NE 7TH ST
POMPANO BEACH FL
33060-6332
US

V. Phone/Fax

Practice location:
  • Phone: 954-774-9469
  • Fax:
Mailing address:
  • Phone: 314-706-7101
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code247200000X
TaxonomyOther Technician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: