Provider Demographics
NPI:1881292654
Name:JOHNSON, MEGAN SHEILA (AUD)
Entity type:Individual
Prefix:MRS
First Name:MEGAN
Middle Name:SHEILA
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:MS
Other - First Name:MEGAN
Other - Middle Name:SHEILA
Other - Last Name:NOWACKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:AUD
Mailing Address - Street 1:229 PARRISH STREET
Mailing Address - Street 2:SUITE 250
Mailing Address - City:CANANDAIGUA
Mailing Address - State:NY
Mailing Address - Zip Code:14424-1791
Mailing Address - Country:US
Mailing Address - Phone:585-412-6967
Mailing Address - Fax:585-398-1212
Practice Address - Street 1:229 PARRISH STREET
Practice Address - Street 2:SUITE 250
Practice Address - City:CANANDAIGUA
Practice Address - State:NY
Practice Address - Zip Code:14424-1791
Practice Address - Country:US
Practice Address - Phone:585-412-6967
Practice Address - Fax:585-398-1212
Is Sole Proprietor?:No
Enumeration Date:2020-10-14
Last Update Date:2024-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY14000063598231H00000X
NY002999-01231H00000X
NY002999231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist