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NPI 1376024042

NPI 1376024042 : MEGHANN LASSI ATC : BUFFALO, NY

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General NPI Number Information
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    NPI Number           |    1376024042
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    Entity Type          |    Individual 
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    Provider Name        |    MEGHANN LASSI ATC
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    Gender               |    Female 
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Dates
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    Enumeration Date     |    08/22/2018
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    Last Update Date     |    06/23/2020
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Provider Practice Location Address
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    Address Line         |    20 ALUMNI ARENA 
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    City                 |    BUFFALO
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    State                |    NY
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    Zip                  |    14260-1659
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    Country              |    US
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    Telephone            |    716-645-6471
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    Fax                  |    
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Provider Business Mailing Address
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    Address Line         |    20 ALUMNI ARENA 
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    City                 |    BUFFALO
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    State                |    NY
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    Zip                  |    14260-1659
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    Country              |    US
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    Telephone            |    
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    Fax                  |    
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Authorized Official
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    Title or Position    |    
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    Name                 |        
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    Credential           |    
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    Telephone            |    
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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    Taxonomy Code        |    2255A2300X
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    Taxonomy Name        |    Athletic Trainer
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    License Number       |    RT006127
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    License Number State |    PA
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