=====================================================
General NPI Number Information
=====================================================
NPI Number | 1942928254
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MEAGHAN ROSE DOHERTY CCC-SLP
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/22/2022
-----------------------------------------------------
Last Update Date | 10/03/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 300 GARDEN CITY PLZ STE 350
-----------------------------------------------------
City | GARDEN CITY
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11530-3358
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 516-747-9030
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 24 SYRACUSE ST
-----------------------------------------------------
City | WILLISTON PARK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11596-1334
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 516-662-9811
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 235Z00000X
-----------------------------------------------------
Taxonomy Name | Speech-Language Pathologist
-----------------------------------------------------
License Number | 033138-01
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------