Provider Demographics
NPI:1508018524
Name:BRADY, MEGAN KATHRYN (CNM)
Entity Type:Individual
Prefix:
First Name:MEGAN
Middle Name:KATHRYN
Last Name:BRADY
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:640 LIBERTY ST
Mailing Address - Street 2:
Mailing Address - City:PENN YAN
Mailing Address - State:NY
Mailing Address - Zip Code:14527-1035
Mailing Address - Country:US
Mailing Address - Phone:315-759-5115
Mailing Address - Fax:315-759-5115
Practice Address - Street 1:640 LIBERTY ST
Practice Address - Street 2:
Practice Address - City:PENN YAN
Practice Address - State:NY
Practice Address - Zip Code:14527-1035
Practice Address - Country:US
Practice Address - Phone:315-759-5115
Practice Address - Fax:315-759-5115
Is Sole Proprietor?:No
Enumeration Date:2008-10-22
Last Update Date:2023-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA284965367A00000X
NY001988176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife
No367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife