Provider Demographics
NPI:1003178328
Name:KEHOE, MICHELLE ANNE (MSED, EDM)
Entity Type:Individual
Prefix:MRS
First Name:MICHELLE
Middle Name:ANNE
Last Name:KEHOE
Suffix:
Gender:F
Credentials:MSED, EDM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:157 COUNTRYSIDE LN
Mailing Address - Street 2:
Mailing Address - City:GRAND ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:14072-2517
Mailing Address - Country:US
Mailing Address - Phone:716-830-1506
Mailing Address - Fax:
Practice Address - Street 1:157 COUNTRYSIDE LN
Practice Address - Street 2:
Practice Address - City:GRAND ISLAND
Practice Address - State:NY
Practice Address - Zip Code:14072-2517
Practice Address - Country:US
Practice Address - Phone:716-830-1506
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-12
Last Update Date:2012-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist