Provider Demographics
NPI:1962757815
Name:STELLA, MEGHAN ANNE (MS CHILDHOOD ED)
Entity type:Individual
Prefix:
First Name:MEGHAN
Middle Name:ANNE
Last Name:STELLA
Suffix:
Gender:F
Credentials:MS CHILDHOOD ED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:251 NEW HAMPSHIRE AVE
Mailing Address - Street 2:
Mailing Address - City:MASSAPEQUA
Mailing Address - State:NY
Mailing Address - Zip Code:11758-4021
Mailing Address - Country:US
Mailing Address - Phone:516-242-6613
Mailing Address - Fax:
Practice Address - Street 1:251 NEW HAMPSHIRE AVE
Practice Address - Street 2:
Practice Address - City:MASSAPEQUA
Practice Address - State:NY
Practice Address - Zip Code:11758-4021
Practice Address - Country:US
Practice Address - Phone:516-242-6613
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-17
Last Update Date:2014-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH92781252Y00000X
NY741399131252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency