Healthcare Provider Details

I. General information

NPI: 1053048298
Provider Name (Legal Business Name): MEGHAN E FADELEY PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/08/2022
Last Update Date: 09/30/2025
Certification Date: 09/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

833 CANANDAIGUA RD
GENEVA NY
14456-2015
US

IV. Provider business mailing address

100 KINGS HWY S
ROCHESTER NY
14617-5504
US

V. Phone/Fax

Practice location:
  • Phone: 315-787-5155
  • Fax: 315-787-5151
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number028585
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: