Provider Demographics
NPI:1376808956
Name:FARRELL, MEGHAN (MSED)
Entity Type:Individual
Prefix:MISS
First Name:MEGHAN
Middle Name:
Last Name:FARRELL
Suffix:
Gender:F
Credentials:MSED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12A PAUCHOGUE AVE
Mailing Address - Street 2:
Mailing Address - City:EAST ISLIP
Mailing Address - State:NY
Mailing Address - Zip Code:11730
Mailing Address - Country:US
Mailing Address - Phone:631-666-1954
Mailing Address - Fax:
Practice Address - Street 1:12A PAUCHOGUE AVE
Practice Address - Street 2:
Practice Address - City:EAST ISLIP
Practice Address - State:NY
Practice Address - Zip Code:11730-2543
Practice Address - Country:US
Practice Address - Phone:631-666-1954
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-10
Last Update Date:2012-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY880932174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY880932OtherSPECIAL EDUCATOR GRADES 1-6
NY880932OtherSPECIAL EDUCATOR BIRTH-GRADE 2