Provider Demographics
NPI:1821413139
Name:CARROLL, MEGAN (MSED)
Entity Type:Individual
Prefix:MRS
First Name:MEGAN
Middle Name:
Last Name:CARROLL
Suffix:
Gender:F
Credentials:MSED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:322 ROBERT DR
Mailing Address - Street 2:APT 6
Mailing Address - City:NORTH TONAWANDA
Mailing Address - State:NY
Mailing Address - Zip Code:14120-5647
Mailing Address - Country:US
Mailing Address - Phone:716-609-9977
Mailing Address - Fax:
Practice Address - Street 1:43 E MAIN ST
Practice Address - Street 2:UPPER
Practice Address - City:SPRINGVILLE
Practice Address - State:NY
Practice Address - Zip Code:14141-1224
Practice Address - Country:US
Practice Address - Phone:716-794-3535
Practice Address - Fax:716-794-3536
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-24
Last Update Date:2014-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY725039131174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist