Healthcare Provider Details

I. General information

NPI: 1306350525
Provider Name (Legal Business Name): MEGAN O'SHEA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/27/2017
Last Update Date: 11/27/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9 4TH AVE
BAY SHORE NY
11706-7908
US

IV. Provider business mailing address

97 INTERVALE AVE
FARMINGDALE NY
11735-5828
US

V. Phone/Fax

Practice location:
  • Phone: 631-665-6707
  • Fax: 631-665-3564
Mailing address:
  • Phone: 516-655-4018
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number099466-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: