Provider Demographics
NPI:1861072985
Name:MASEDA, MEGHAN CAREY DERKEN
Entity type:Individual
Prefix:
First Name:MEGHAN
Middle Name:CAREY DERKEN
Last Name:MASEDA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MEGHAN
Other - Middle Name:CAREY
Other - Last Name:DERKEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:40 SUNSHINE COTTAGE RD
Mailing Address - Street 2:
Mailing Address - City:VALHALLA
Mailing Address - State:NY
Mailing Address - Zip Code:10595-1524
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:40 SUNSHINE COTTAGE RD
Practice Address - Street 2:
Practice Address - City:VALHALLA
Practice Address - State:NY
Practice Address - Zip Code:10595-1524
Practice Address - Country:US
Practice Address - Phone:203-887-8182
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-12
Last Update Date:2021-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program