Provider Demographics
NPI:1114559846
Name:SHANK, MEGHAN C (PMHNP)
Entity type:Individual
Prefix:MRS
First Name:MEGHAN
Middle Name:C
Last Name:SHANK
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:MEGHAN
Other - Middle Name:C
Other - Last Name:SKRYNECKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PMHNP
Mailing Address - Street 1:1355 BEVERLY ROAD
Mailing Address - Street 2:SUITE 225
Mailing Address - City:MCLEAN
Mailing Address - State:VA
Mailing Address - Zip Code:22101
Mailing Address - Country:US
Mailing Address - Phone:703-408-7327
Mailing Address - Fax:571-297-6277
Practice Address - Street 1:18 E 48TH ST RM 1202
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10017-1038
Practice Address - Country:US
Practice Address - Phone:646-846-0139
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-11
Last Update Date:2022-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024181416363LP0808X
MDR230592363LP0808X
NYF404458-01363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health