Healthcare Provider Details

I. General information

NPI: 1083317101
Provider Name (Legal Business Name): MEGAN SEALEY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/27/2023
Last Update Date: 03/27/2023
Certification Date: 03/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4813 W MERCURY BLVD
HAMPTON VA
23666-3727
US

IV. Provider business mailing address

712 JAMES DR
NEWPORT NEWS VA
23605-2316
US

V. Phone/Fax

Practice location:
  • Phone: 757-826-2792
  • Fax:
Mailing address:
  • Phone: 757-508-2255
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License Number30115332
License Number StateDC
# 2
Primary TaxonomyY
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License Number0230034754
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: