Provider Demographics
NPI:1740022920
Name:MCCANN, MEGAN (RDN, CDN, LDN)
Entity type:Individual
Prefix:
First Name:MEGAN
Middle Name:
Last Name:MCCANN
Suffix:
Gender:F
Credentials:RDN, CDN, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 831
Mailing Address - Street 2:
Mailing Address - City:GRAND ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:14072-0831
Mailing Address - Country:US
Mailing Address - Phone:716-704-0684
Mailing Address - Fax:
Practice Address - Street 1:1990 WHITEHAVEN RD
Practice Address - Street 2:
Practice Address - City:GRAND ISLAND
Practice Address - State:NY
Practice Address - Zip Code:14072-1846
Practice Address - Country:US
Practice Address - Phone:716-704-0684
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-10
Last Update Date:2024-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY012128133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered