Healthcare Provider Details

I. General information

NPI: 1023940558
Provider Name (Legal Business Name): MEGAN JUDITH PEDDLE RBT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/01/2026
Last Update Date: 06/01/2026
Certification Date: 05/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5033 GEORGE WASHINGTON MEM HWY UNIT C
YORKTOWN VA
23692-2510
US

IV. Provider business mailing address

2027 MELBOURNE ST
NEWPORT NEWS VA
23608-7777
US

V. Phone/Fax

Practice location:
  • Phone: 631-901-3711
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: