Provider Demographics
NPI:1093239089
Name:TUDOR, MEGAN E (PHD)
Entity Type:Individual
Prefix:DR
First Name:MEGAN
Middle Name:E
Last Name:TUDOR
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2825 50TH ST
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95817-2310
Mailing Address - Country:US
Mailing Address - Phone:916-703-0365
Mailing Address - Fax:
Practice Address - Street 1:2825 50TH ST
Practice Address - Street 2:UC DAVIS MIND INSTITUTE
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95817
Practice Address - Country:US
Practice Address - Phone:909-556-9641
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-01
Last Update Date:2018-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA29341103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent