Provider Demographics
NPI:1437865045
Name:MCDONOUGH, MEGHAN RAE (PMHNP)
Entity Type:Individual
Prefix:
First Name:MEGHAN
Middle Name:RAE
Last Name:MCDONOUGH
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4561 BEACH RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:LOCKPORT
Mailing Address - State:NY
Mailing Address - Zip Code:14094-9638
Mailing Address - Country:US
Mailing Address - Phone:716-550-1262
Mailing Address - Fax:
Practice Address - Street 1:17 LIMESTONE DR STE 5
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14221-8601
Practice Address - Country:US
Practice Address - Phone:716-550-1262
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-26
Last Update Date:2023-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF404692-01363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health