Provider Demographics
NPI:1922269562
Name:TEODOSIO, MEGAN R
Entity Type:Individual
Prefix:MS
First Name:MEGAN
Middle Name:R
Last Name:TEODOSIO
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 1:1427 COMMONWEALTH AVENUE
Mailing Address - Street 2:#102
Mailing Address - City:BRIGHTON
Mailing Address - State:MA
Mailing Address - Zip Code:02135
Mailing Address - Country:US
Mailing Address - Phone:203-530-0542
Mailing Address - Fax:
Practice Address - Street 1:1427 COMMONWEALTH AVE
Practice Address - Street 2:#102
Practice Address - City:BRIGHTON
Practice Address - State:MA
Practice Address - Zip Code:02135-6254
Practice Address - Country:US
Practice Address - Phone:203-530-0542
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-17
Last Update Date:2008-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist