Healthcare Provider Details

I. General information

NPI: 1306384896
Provider Name (Legal Business Name): MEGAN CHRISTINA SACCENTE DFNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/06/2017
Last Update Date: 10/04/2021
Certification Date: 10/04/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2177 VICTORY BLVD
STATEN ISLAND NY
10314-6603
US

IV. Provider business mailing address

2177 VICTORY BLVD
STATEN ISLAND NY
10314-6603
US

V. Phone/Fax

Practice location:
  • Phone: 718-370-3730
  • Fax:
Mailing address:
  • Phone: 718-370-3730
  • Fax: 718-698-9412

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number341391
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: