Healthcare Provider Details

I. General information

NPI: 1912638529
Provider Name (Legal Business Name): MEGAN FAULKNER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/23/2022
Last Update Date: 10/21/2025
Certification Date: 10/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

144 GENESEE ST STE 201
AUBURN NY
13021-3529
US

IV. Provider business mailing address

144 GENESEE ST STE 500
AUBURN NY
13021-3599
US

V. Phone/Fax

Practice location:
  • Phone: 315-253-8477
  • Fax: 315-515-3191
Mailing address:
  • Phone: 315-253-8477
  • Fax: 315-253-4727

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number50.008530RX
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number031109
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: