Healthcare Provider Details

I. General information

NPI: 1679451322
Provider Name (Legal Business Name): MEGAN CASSIDY POWELL BSN, RN, CNRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/21/2025
Last Update Date: 08/21/2025
Certification Date: 08/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

55 FRUIT ST WANG 835
BOSTON MA
02114
US

IV. Provider business mailing address

1 OAK GROVE AVE UNIT 215
MELROSE MA
02176-6118
US

V. Phone/Fax

Practice location:
  • Phone: 617-726-7565
  • Fax:
Mailing address:
  • Phone: 770-634-2444
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WN0800X
TaxonomyNeuroscience Registered Nurse
License Number00398817
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN2382739
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: