Provider Demographics
NPI:1952554164
Name:D'AVERSA, MEGHAN ELIZABETH (RPA-C)
Entity type:Individual
Prefix:MRS
First Name:MEGHAN
Middle Name:ELIZABETH
Last Name:D'AVERSA
Suffix:
Gender:F
Credentials:RPA-C
Other - Prefix:MISS
Other - First Name:MEGHAN
Other - Middle Name:ELIZABETH
Other - Last Name:DEROSA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RPA-C
Mailing Address - Street 1:120 MINEOLA BLVD STE 410
Mailing Address - Street 2:
Mailing Address - City:MINEOLA
Mailing Address - State:NY
Mailing Address - Zip Code:11501-4077
Mailing Address - Country:US
Mailing Address - Phone:516-663-2097
Mailing Address - Fax:516-663-2946
Practice Address - Street 1:120 MINEOLA BLVD STE 410
Practice Address - Street 2:
Practice Address - City:MINEOLA
Practice Address - State:NY
Practice Address - Zip Code:11501-4077
Practice Address - Country:US
Practice Address - Phone:516-663-2097
Practice Address - Fax:516-663-2946
Is Sole Proprietor?:No
Enumeration Date:2008-10-31
Last Update Date:2021-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY011734-1363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant