Provider Demographics
NPI:1841097599
Name:LYNAM, MEGAN (RD)
Entity type:Individual
Prefix:
First Name:MEGAN
Middle Name:
Last Name:LYNAM
Suffix:
Gender:
Credentials:RD
Other - Prefix:
Other - First Name:MEGAN
Other - Middle Name:
Other - Last Name:BESHARA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD
Mailing Address - Street 1:48425 GYDE RD
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:MI
Mailing Address - Zip Code:48187-1217
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:48425 GYDE RD
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:MI
Practice Address - Zip Code:48187-1217
Practice Address - Country:US
Practice Address - Phone:248-821-3501
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-28
Last Update Date:2025-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1039704133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered