Provider Demographics
NPI:1386095727
Name:MEEHAN, KAYLA
Entity type:Individual
Prefix:
First Name:KAYLA
Middle Name:
Last Name:MEEHAN
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 1:380 CYPRESS DR
Mailing Address - Street 2:
Mailing Address - City:COLONIA
Mailing Address - State:NJ
Mailing Address - Zip Code:07067-1431
Mailing Address - Country:US
Mailing Address - Phone:732-850-5422
Mailing Address - Fax:
Practice Address - Street 1:10 PARSONAGE RD
Practice Address - Street 2:SUITE 318
Practice Address - City:EDISON
Practice Address - State:NJ
Practice Address - Zip Code:08837-2429
Practice Address - Country:US
Practice Address - Phone:732-204-1635
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-27
Last Update Date:2016-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist