Provider Demographics
NPI:1497086938
Name:FAY, MEGAN ELIZABETH (LPN)
Entity Type:Individual
Prefix:
First Name:MEGAN
Middle Name:ELIZABETH
Last Name:FAY
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:798 BROOKRIDGE DR
Mailing Address - Street 2:APT 14
Mailing Address - City:VALLEY COTTAGE
Mailing Address - State:NY
Mailing Address - Zip Code:10989-1851
Mailing Address - Country:US
Mailing Address - Phone:845-825-2830
Mailing Address - Fax:
Practice Address - Street 1:798 BROOKRIDGE DR
Practice Address - Street 2:APT 14
Practice Address - City:VALLEY COTTAGE
Practice Address - State:NY
Practice Address - Zip Code:10989-1851
Practice Address - Country:US
Practice Address - Phone:845-825-2830
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-01-22
Last Update Date:2010-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY297727164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY297727OtherLICENSED PRACTICAL NURSE