Provider Demographics
NPI:1174001846
Name:SACCONE, MEREDITH A (CRNA)
Entity Type:Individual
Prefix:
First Name:MEREDITH
Middle Name:A
Last Name:SACCONE
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:MEREDITH
Other - Middle Name:
Other - Last Name:PETTY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:255 W 84TH ST APT 2D
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10024-4326
Mailing Address - Country:US
Mailing Address - Phone:978-270-0305
Mailing Address - Fax:
Practice Address - Street 1:1 DIAMOND HILL RD
Practice Address - Street 2:
Practice Address - City:BERKELEY HEIGHTS
Practice Address - State:NJ
Practice Address - Zip Code:07922-2104
Practice Address - Country:US
Practice Address - Phone:908-977-9376
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-03
Last Update Date:2023-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY629784-01163W00000X
NJ26NJ00869300367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse