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Meghan Licciardello

Physician Assistant

Physician Assistants & Advanced Practice Nursing Providers

1451 River Park Dr Ste 260, Sacramento, CA 95815-4504

PECOS Enrollment

Based on the most recent information from CMS, provider Meghan Licciardello is legally eligible to order and refer claims for Part B, HHA, DME and PMD services.

Part B
Medicare Part B
Enrolled
HHA
Home Health Agency
Enrolled
DME
Durable Medical Equipment
Enrolled
PMD
Power Mobility Device
Enrolled

CMS last updated its PECOS records 3 days ago.

Profile Details

Provider ID
1689212482
Provider Type
Individual
Full Name
Licciardello, Meghan
Credential
PA

Gender
Female
Sole Proprietor
No
Enumeration Date
12/12/2019
Last Updated
10/1/2021

Contact Information

Practice Location

1451 River Park Dr Ste 260, Sacramento, CA 95815-4504

(650) 826-2945

Unlisted Fax

Mailing Location

300 Harding Blvd Ste 213, Roseville, CA 95678-2474

(916) 390-1347

Unlisted Fax

Provider Taxonomies

Code	Description	License
Code 363A00000X Primary	Description Physician Assistant Physician Assistants & Advanced Practice Nursing Providers	License Unlisted Issuer

Meghan Licciardello

PECOS Enrollment

Profile Details

Contact Information

Practice Location

Mailing Location

Provider Taxonomies

Code

Description

License

Code

Description

License

Samimi, Marjon Homeyra

Shamsian, Dalia

Michalsky, Mikayla

Guletz, Hannah

Goldfarb, David

Rosselli, Jordanna

Chhun, May

Hurtado, Tatiana Monique

Patel, Ekta

Zarco, Osvaldo