Provider Demographics
NPI:1235672833
Name:GONNELLY, MEGAN (MA)
Entity Type:Individual
Prefix:MRS
First Name:MEGAN
Middle Name:
Last Name:GONNELLY
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:475 CINNAMON DR
Mailing Address - Street 2:
Mailing Address - City:SATELLITE BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32937-3124
Mailing Address - Country:US
Mailing Address - Phone:321-626-6486
Mailing Address - Fax:
Practice Address - Street 1:484 N WICKHAM RD APT 144
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32935-8642
Practice Address - Country:US
Practice Address - Phone:321-626-6486
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-30
Last Update Date:2019-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist