Provider Demographics
NPI:1083032874
Name:MEGARO, JILLIAN
Entity type:Individual
Prefix:
First Name:JILLIAN
Middle Name:
Last Name:MEGARO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:369 WALDOBORO RD
Mailing Address - Street 2:
Mailing Address - City:BREMEN
Mailing Address - State:ME
Mailing Address - Zip Code:04551-3305
Mailing Address - Country:US
Mailing Address - Phone:508-308-8228
Mailing Address - Fax:
Practice Address - Street 1:135 MADEIRA AVE
Practice Address - Street 2:
Practice Address - City:CORAL GABLES
Practice Address - State:FL
Practice Address - Zip Code:33134-4515
Practice Address - Country:US
Practice Address - Phone:305-204-7992
Practice Address - Fax:508-213-3687
Is Sole Proprietor?:No
Enumeration Date:2014-03-31
Last Update Date:2025-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPA4978363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant