Provider Demographics
NPI:1871848879
Name:PICCIANO, MEGHAN KATIE
Entity Type:Individual
Prefix:MRS
First Name:MEGHAN
Middle Name:KATIE
Last Name:PICCIANO
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 1:29 PETTY LN
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:NY
Mailing Address - Zip Code:11763-2629
Mailing Address - Country:US
Mailing Address - Phone:631-569-2200
Mailing Address - Fax:631-569-2200
Practice Address - Street 1:5225 NESCONSET HWY
Practice Address - Street 2:SUITE 30
Practice Address - City:PORT JEFF STA
Practice Address - State:NY
Practice Address - Zip Code:11776-2053
Practice Address - Country:US
Practice Address - Phone:631-473-4284
Practice Address - Fax:631-331-2204
Is Sole Proprietor?:No
Enumeration Date:2012-07-17
Last Update Date:2012-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1917862174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist