Healthcare Provider Details

I. General information

NPI: 1154725497
Provider Name (Legal Business Name): MEGHAN O'NEILL PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/15/2014
Last Update Date: 02/24/2023
Certification Date: 11/24/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 NICOLLS RD HSC- L4, RM 050
STONY BROOK NY
11794-8350
US

IV. Provider business mailing address

50 PINE ST
BLUE POINT NY
11715-1118
US

V. Phone/Fax

Practice location:
  • Phone: 631-444-2478
  • Fax:
Mailing address:
  • Phone: 631-697-6956
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number018121-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: