Provider Demographics
NPI:1811381429
Name:PESYNA, MEGAN ANNETTE (DO)
Entity Type:Individual
Prefix:
First Name:MEGAN
Middle Name:ANNETTE
Last Name:PESYNA
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:801 BREWSTER AVE STE 175
Mailing Address - Street 2:
Mailing Address - City:REDWOOD CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94063-1559
Mailing Address - Country:US
Mailing Address - Phone:650-216-7794
Mailing Address - Fax:
Practice Address - Street 1:801 BREWSTER AVE STE 175
Practice Address - Street 2:
Practice Address - City:REDWOOD CITY
Practice Address - State:CA
Practice Address - Zip Code:94063-1559
Practice Address - Country:US
Practice Address - Phone:650-216-7794
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-03-20
Last Update Date:2018-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A16354208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics