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NPI Code Detail

MEDICARE: MRS. MEGAN MAYNARD PA-C

MEDICARE: MRS. MEGAN MAYNARD PA-C
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363AM0700XMedical Physician AssistantPA 9107017FL

General Provider Information

NPI Number : 1164762936
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. MEGAN MAYNARD PA-C
Provider Business Mailing Address
First Line : 709 S HARBOR CITY BLVD STE 100
Second Line :
City : MELBOURNE
State : FL
Zip : 32901-1936
Country : US
Telephone Number : 321-725-2225
Fax Number : 321-308-0635
Provider Business Practice Location Address
First Line : 709 S HARBOR CITY BLVD STE 100
Second Line :
City : MELBOURNE
State : FL
Zip : 32901-1936
Country : US
Telephone Number : 321-725-2225
Fax Number : 321-308-0635
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/15/2013
Last Update Date : 07/01/2013

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Directions to “ MRS. MEGAN MAYNARD PA-C” Practice Location

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