Provider Demographics
NPI:1043054745
Name:VINCENT, MEGAN A (PMHNP)
Entity type:Individual
Prefix:
First Name:MEGAN
Middle Name:A
Last Name:VINCENT
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:163 FRANKLIN AVE
Mailing Address - Street 2:
Mailing Address - City:MALVERNE
Mailing Address - State:NY
Mailing Address - Zip Code:11565-1929
Mailing Address - Country:US
Mailing Address - Phone:516-647-9035
Mailing Address - Fax:
Practice Address - Street 1:775 PARK AVE STE 154
Practice Address - Street 2:
Practice Address - City:HUNTINGTON
Practice Address - State:NY
Practice Address - Zip Code:11743-5162
Practice Address - Country:US
Practice Address - Phone:631-427-1100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-19
Last Update Date:2024-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF405954-01363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health