Provider Demographics
NPI:1396991436
Name:SINON, MEGHAN D (PA-C)
Entity type:Individual
Prefix:MS
First Name:MEGHAN
Middle Name:D
Last Name:SINON
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MS
Other - First Name:MAGHAN
Other - Middle Name:E
Other - Last Name:DOERR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:12639 OLD TESSON RD
Mailing Address - Street 2:SUITE 115
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63128-2786
Mailing Address - Country:US
Mailing Address - Phone:314-849-0311
Mailing Address - Fax:314-849-4423
Practice Address - Street 1:12639 OLD TESSON RD
Practice Address - Street 2:SUITE 115
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63128-2786
Practice Address - Country:US
Practice Address - Phone:314-849-0311
Practice Address - Fax:314-849-0311
Is Sole Proprietor?:No
Enumeration Date:2008-08-08
Last Update Date:2021-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2010029585363AS0400X
363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHPA31541Medicare PIN