Healthcare Provider Details

I. General information

NPI: 1225984693
Provider Name (Legal Business Name): MEGAN MARIE BEACH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/09/2026
Last Update Date: 03/09/2026
Certification Date: 03/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

901 E MAIN ST STE 508
RIVERHEAD NY
11901-2680
US

IV. Provider business mailing address

1598 FEUEREISEN AVE
BOHEMIA NY
11716-1528
US

V. Phone/Fax

Practice location:
  • Phone: 631-902-6414
  • Fax: 888-634-7125
Mailing address:
  • Phone: 516-480-6387
  • Fax: 888-634-7125

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License Number674649
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: