Provider Demographics
NPI:1619440492
Name:LYE, MEGAN RENE
Entity Type:Individual
Prefix:
First Name:MEGAN
Middle Name:RENE
Last Name:LYE
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 1:5501 MECHANICSVILLE TPKE
Mailing Address - Street 2:
Mailing Address - City:MECHANICSVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:23111-6400
Mailing Address - Country:US
Mailing Address - Phone:804-723-3600
Mailing Address - Fax:804-723-3605
Practice Address - Street 1:5501 MECHANICSVILLE TPKE
Practice Address - Street 2:
Practice Address - City:MECHANICSVILLE
Practice Address - State:VA
Practice Address - Zip Code:23111-6400
Practice Address - Country:US
Practice Address - Phone:804-723-3600
Practice Address - Fax:804-723-3605
Is Sole Proprietor?:No
Enumeration Date:2019-01-04
Last Update Date:2019-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2202007776235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist