Healthcare Provider Details

I. General information

NPI: 1790637726
Provider Name (Legal Business Name): MEGAN MERRELL FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/11/2026
Last Update Date: 02/11/2026
Certification Date: 02/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

48 BRANDIS AVE
STATEN ISLAND NY
10312-2006
US

IV. Provider business mailing address

48 BRANDIS AVE
STATEN ISLAND NY
10312-2006
US

V. Phone/Fax

Practice location:
  • Phone: 718-689-3701
  • Fax:
Mailing address:
  • Phone: 718-689-3701
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number358872
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: