Provider Demographics
NPI:1639643562
Name:NUNZIATO, MEAGAN JANE (PA-C)
Entity Type:Individual
Prefix:
First Name:MEAGAN
Middle Name:JANE
Last Name:NUNZIATO
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:MEAGAN
Other - Middle Name:JANE
Other - Last Name:KEANE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:40 SHORE DR
Mailing Address - Street 2:
Mailing Address - City:OAKDALE
Mailing Address - State:NY
Mailing Address - Zip Code:11769-1924
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:40 SHORE DR
Practice Address - Street 2:
Practice Address - City:OAKDALE
Practice Address - State:NY
Practice Address - Zip Code:11769-1924
Practice Address - Country:US
Practice Address - Phone:631-750-3468
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-14
Last Update Date:2022-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY05650679Medicaid