Provider Demographics
NPI:1144706342
Name:DESPOTIDIS, MEGHAN A (AUD)
Entity type:Individual
Prefix:
First Name:MEGHAN
Middle Name:A
Last Name:DESPOTIDIS
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33 FALCON DR
Mailing Address - Street 2:
Mailing Address - City:HAUPPAUGE
Mailing Address - State:NY
Mailing Address - Zip Code:11788-1204
Mailing Address - Country:US
Mailing Address - Phone:908-692-9834
Mailing Address - Fax:
Practice Address - Street 1:180 FORT WASHINGTON AVE FL 7
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10032-3722
Practice Address - Country:US
Practice Address - Phone:212-305-0029
Practice Address - Fax:315-443-4413
Is Sole Proprietor?:No
Enumeration Date:2018-07-11
Last Update Date:2022-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY002820231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist