Provider Demographics
NPI:1780302265
Name:BASHAW, MEAGHAN ALYSSA (LISW)
Entity type:Individual
Prefix:
First Name:MEAGHAN
Middle Name:ALYSSA
Last Name:BASHAW
Suffix:
Gender:F
Credentials:LISW
Other - Prefix:
Other - First Name:MEAGHAN
Other - Middle Name:ALYSSA
Other - Last Name:MINOR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2780 AIRPORT DR STE 100
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43219-2289
Mailing Address - Country:US
Mailing Address - Phone:614-859-1906
Mailing Address - Fax:614-458-1849
Practice Address - Street 1:1180 E MAIN ST
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43205-1902
Practice Address - Country:US
Practice Address - Phone:614-645-5535
Practice Address - Fax:614-645-5545
Is Sole Proprietor?:No
Enumeration Date:2022-08-19
Last Update Date:2022-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHLD.09673133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered