Provider Demographics
NPI:1952695116
Name:SPERRY, MEGHAN L (CNM)
Entity type:Individual
Prefix:
First Name:MEGHAN
Middle Name:L
Last Name:SPERRY
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17 CENTRAL ST
Mailing Address - Street 2:UNIT 1
Mailing Address - City:RANDOLPH
Mailing Address - State:VT
Mailing Address - Zip Code:05060-1039
Mailing Address - Country:US
Mailing Address - Phone:802-431-6030
Mailing Address - Fax:803-735-1664
Practice Address - Street 1:17 CENTRAL ST
Practice Address - Street 2:UNIT 1
Practice Address - City:RANDOLPH
Practice Address - State:VT
Practice Address - Zip Code:05060-1039
Practice Address - Country:US
Practice Address - Phone:802-431-6030
Practice Address - Fax:803-735-1664
Is Sole Proprietor?:No
Enumeration Date:2011-06-06
Last Update Date:2024-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT101.0077848367A00000X
NH064181-23367A00000X
CT16.000565367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT1019229Medicaid