Healthcare Provider Details

I. General information

NPI: 1467384362
Provider Name (Legal Business Name): MEGAN ALLIE REYNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MARS REYNA MOREA

II. Dates (important events)

Enumeration Date: 06/02/2026
Last Update Date: 06/02/2026
Certification Date: 06/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2376 MONROE AVE
ROCHESTER NY
14618-3032
US

IV. Provider business mailing address

125 CARTER ST APT 3
ROCHESTER NY
14621-5126
US

V. Phone/Fax

Practice location:
  • Phone: 585-430-9877
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code221700000X
TaxonomyArt Therapist
License NumberP142783
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: