Healthcare Provider Details

I. General information

NPI: 1780257592
Provider Name (Legal Business Name): MEGHAN ANNE SLOAN PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/20/2021
Last Update Date: 01/22/2026
Certification Date: 01/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5100 SUNRISE HWY
MASSAPEQUA PARK NY
11762-2935
US

IV. Provider business mailing address

5100 SUNRISE HWY
MASSAPEQUA PARK NY
11762-2935
US

V. Phone/Fax

Practice location:
  • Phone: 631-646-4357
  • Fax:
Mailing address:
  • Phone: 631-646-4357
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number026233
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: