Healthcare Provider Details

I. General information

NPI: 1760166862
Provider Name (Legal Business Name): MEGHA MOKKAPATI
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/12/2023
Last Update Date: 06/12/2023
Certification Date: 06/07/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7233 BALTIC CT
CINCINNATI OH
45244-4269
US

IV. Provider business mailing address

521 MLK DR W APT C36
CINCINNATI OH
45220-3002
US

V. Phone/Fax

Practice location:
  • Phone: 409-763-3652
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code385HR2060X
TaxonomyChild Intellectual and/or Developmental Disabilities Respite Care
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: