Provider Demographics
NPI:1245026988
Name:VALLA, MEGAN CLAIRE
Entity type:Individual
Prefix:
First Name:MEGAN
Middle Name:CLAIRE
Last Name:VALLA
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:279 PINTORESCO DR
Mailing Address - Street 2:
Mailing Address - City:SAINT AUGUSTINE
Mailing Address - State:FL
Mailing Address - Zip Code:32095-1643
Mailing Address - Country:US
Mailing Address - Phone:201-739-4262
Mailing Address - Fax:
Practice Address - Street 1:279 PINTORESCO DR
Practice Address - Street 2:
Practice Address - City:SAINT AUGUSTINE
Practice Address - State:FL
Practice Address - Zip Code:32095-1643
Practice Address - Country:US
Practice Address - Phone:201-739-4262
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-18
Last Update Date:2025-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist