MEDICARE: MEGAN DELILAH CORREA 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
1	363AM0700X	Medical Physician Assistant	PA9115034	FL
2	363AM0700X	Medical Physician Assistant	13100576-1206	UT
3	363A00000X	Physician Assistant		FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1639849755
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MEGAN DELILAH CORREA PA-C

Provider Business Mailing Address
First Line	:	6686 S HIGHLAND DR
Second Line	:
City	:	COTTONWOOD HEIGHTS
State	:	UT
Zip	:	84121-3037
Country	:	US
Telephone Number	:	385-425-0908
Fax Number	:

Provider Business Practice Location Address
First Line	:	6686 S HIGHLAND DR
Second Line	:
City	:	COTTONWOOD HEIGHTS
State	:	UT
Zip	:	84121-3037
Country	:	US
Telephone Number	:	385-425-0908
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/20/2021
Last Update Date	:	06/07/2023

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