Provider Demographics
NPI:1558707125
Name:SEDORUS, MEGHAN KENNEDY
Entity Type:Individual
Prefix:MRS
First Name:MEGHAN
Middle Name:KENNEDY
Last Name:SEDORUS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3635 MELROSE RD
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:NY
Mailing Address - Zip Code:13021-9341
Mailing Address - Country:US
Mailing Address - Phone:315-253-1464
Mailing Address - Fax:315-253-1156
Practice Address - Street 1:8 DILL ST
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:NY
Practice Address - Zip Code:13021-3606
Practice Address - Country:US
Practice Address - Phone:315-253-1464
Practice Address - Fax:315-253-1156
Is Sole Proprietor?:No
Enumeration Date:2013-05-22
Last Update Date:2013-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator