Provider Demographics
NPI:1205011178
Name:GULLO, MEGHAN D (SLP)
Entity Type:Individual
Prefix:
First Name:MEGHAN
Middle Name:D
Last Name:GULLO
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:MEGHAN
Other - Middle Name:C
Other - Last Name:DOLAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:SLP
Mailing Address - Street 1:35 BURTON LN
Mailing Address - Street 2:
Mailing Address - City:HAMBURG
Mailing Address - State:NY
Mailing Address - Zip Code:14075-4337
Mailing Address - Country:US
Mailing Address - Phone:716-913-9831
Mailing Address - Fax:
Practice Address - Street 1:40 CENTRE DR
Practice Address - Street 2:
Practice Address - City:ORCHARD PARK
Practice Address - State:NY
Practice Address - Zip Code:14127-4100
Practice Address - Country:US
Practice Address - Phone:716-776-2294
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-01-09
Last Update Date:2010-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY014155-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist