Provider Demographics
NPI:1194050849
Name:JORDAN, MEGAN O'CONNOR (AUD)
Entity type:Individual
Prefix:DR
First Name:MEGAN
Middle Name:O'CONNOR
Last Name:JORDAN
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:DR
Other - First Name:MEGAN
Other - Middle Name:O'CONNOR
Other - Last Name:MOFFIT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:AUD
Mailing Address - Street 1:6700 KIRKVILLE RD
Mailing Address - Street 2:SUITE 107
Mailing Address - City:EAST SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13057-9305
Mailing Address - Country:US
Mailing Address - Phone:315-463-1724
Mailing Address - Fax:315-463-4020
Practice Address - Street 1:6700 KIRKVILLE RD
Practice Address - Street 2:SUITE 107
Practice Address - City:EAST SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13057-9305
Practice Address - Country:US
Practice Address - Phone:315-463-1724
Practice Address - Fax:315-463-4020
Is Sole Proprietor?:No
Enumeration Date:2009-10-14
Last Update Date:2010-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY002277-1231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYJ400013340Medicare PIN