Provider Demographics
NPI:1225345457
Name:SERRA, MAEGAN ANN (SLP, TSSLD)
Entity Type:Individual
Prefix:
First Name:MAEGAN
Middle Name:ANN
Last Name:SERRA
Suffix:
Gender:F
Credentials:SLP, TSSLD
Other - Prefix:
Other - First Name:MAEGAN
Other - Middle Name:ANN
Other - Last Name:MENESES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:SLP, TSSLD
Mailing Address - Street 1:7121 HINMAN LN
Mailing Address - Street 2:
Mailing Address - City:APEX
Mailing Address - State:NC
Mailing Address - Zip Code:27539-4166
Mailing Address - Country:US
Mailing Address - Phone:516-606-6424
Mailing Address - Fax:
Practice Address - Street 1:1391 KILDAIRE FARM RD STE 1061
Practice Address - Street 2:
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27511-5525
Practice Address - Country:US
Practice Address - Phone:516-606-6424
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-09
Last Update Date:2024-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
174N00000X
NY020549-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
No174N00000XOther Service ProvidersLactation Consultant, Non-RN