=====================================================
General NPI Number Information
=====================================================
NPI Number | 1649731746
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MEENAKSHI ROY MD, MHA
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/29/2019
-----------------------------------------------------
Last Update Date | 09/04/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 509 W UNIVERSITY AVE
-----------------------------------------------------
City | URBANA
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 61801-1645
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 217-383-3440
-----------------------------------------------------
Fax | 217-383-3171
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 611 W PARK ST FAPC
-----------------------------------------------------
City | URBANA
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 61801-2501
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 217-838-3311
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2084N0400X
-----------------------------------------------------
Taxonomy Name | Neurology Physician
-----------------------------------------------------
License Number | 036.164995
-----------------------------------------------------
License Number State | IL
-----------------------------------------------------