MEDICARE: MRS. MEGAN SEVILLA P.A.

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	363A00000X	Physician Assistant	50.007012RX	OH
2	390200000X	Student in an Organized Health Care Education/Training Program

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	:	1922635036
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. MEGAN SEVILLA P.A.

Provider Business Mailing Address
First Line	:	2000 AUBURN DR.
Second Line	:	STE. 350
City	:	BEACHWOOD
State	:	OH
Zip	:	44122-4327
Country	:	US
Telephone Number	:	440-646-1600
Fax Number	:	440-646-1505

Provider Business Practice Location Address
First Line	:	6820 RIDGE ROAD
Second Line	:	STE. 204
City	:	PARMA
State	:	OH
Zip	:	44129-5647
Country	:	US
Telephone Number	:	440-845-1146
Fax Number	:	440-845-4023

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

Provider Enumeration Date	:	03/26/2020
Last Update Date	:	10/23/2025

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