Healthcare Provider Details

I. General information

NPI: 1669851499
Provider Name (Legal Business Name): MEGAN JOY EUDALY P.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/26/2015
Last Update Date: 09/12/2024
Certification Date: 09/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

DC029.01 ONE HOSPITAL DR
COLUMBIA MO
65212-0001
US

IV. Provider business mailing address

5921 E OSAGE RIDGE LN
COLUMBIA MO
65201-8936
US

V. Phone/Fax

Practice location:
  • Phone: 573-883-4400
  • Fax:
Mailing address:
  • Phone: 816-719-7783
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number2015020790
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: