Healthcare Provider Details

I. General information

NPI: 1275165607
Provider Name (Legal Business Name): MEGAN TAKAYE OKUDA PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/04/2020
Last Update Date: 10/03/2024
Certification Date: 10/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

924 COX RD
GASTONIA NC
28054-3456
US

IV. Provider business mailing address

5960 FAIRVIEW RD STE 500
CHARLOTTE NC
28210-3113
US

V. Phone/Fax

Practice location:
  • Phone: 704-800-4268
  • Fax:
Mailing address:
  • Phone: 704-918-1934
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number0010-09776
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: