Provider Demographics
NPI:1073979795
Name:MANN, MEGAN (HAS)
Entity Type:Individual
Prefix:MRS
First Name:MEGAN
Middle Name:
Last Name:MANN
Suffix:
Gender:F
Credentials:HAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:601 E DIXIE AVE
Mailing Address - Street 2:PLAZA 901
Mailing Address - City:LEESBURG
Mailing Address - State:FL
Mailing Address - Zip Code:34748-5953
Mailing Address - Country:US
Mailing Address - Phone:352-343-7279
Mailing Address - Fax:352-343-1618
Practice Address - Street 1:1819 SALK AVE
Practice Address - Street 2:SUITE 2
Practice Address - City:TAVARES
Practice Address - State:FL
Practice Address - Zip Code:32778-4311
Practice Address - Country:US
Practice Address - Phone:352-343-7279
Practice Address - Fax:352-343-1618
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-11
Last Update Date:2016-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAS4928237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist